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HIV-related factors increase risk of stroke
Theo Smart, 2016-03-15 08:00:00

HIV-related risk factors seem to increase the risk of stroke – the sudden death of brain cells due to a rupture or obstruction of blood vessels in the brain – according to ongoing research in a growing number of large epidemiological cohort studies. Recent data from five of these were presented during the first-ever poster discussion session on stroke at the Conference on Retroviruses and Opportunistic Infections (CROI 2016), which took place last month in Boston.

Among the key findings:

  • In addition to traditional cardiovascular risk factors for stroke, HIV-related factors such as viral load and CD4 cell count were significantly associated with the risk of stroke in one study.
  • As in the general population, ischaemic stroke (a stroke due to an obstruction in a blood vessel in the brain) is much more common among people living with HIV than haemorrhagic stroke (when a weakened blood vessel in the brain bulges or ruptures).
  • Age, elevated blood pressure and a CD4 cell count of less than 200 cells/mm3 were the strongest and most common risk predictors in people with HIV for both types of stroke in another study.
  • The association between elevated blood pressure and haemorrhagic stroke appeared slightly stronger, but injecting drug use and a previous AIDS diagnosis, in addition to traditional cardiovascular risk factors, were more strongly associated with ischaemic stroke among people with HIV according to one analysis.
  • Although male sex is a traditional risk factor for stroke, women living with HIV have about twice the risk of stroke as HIV-negative women; however, the risk decreases the longer they are on antiretroviral therapy (ART).
  • A Spanish study showed that stroke incidence and mortality have been decreasing among people living with HIV in the ART era – as long as they do not have hepatitis C virus (HCV); among those with HCV co-infection, stroke incidence and mortality have been steadily increasing, although it is not clear whether this is due to HCV itself or related risk factors such as drug use.
  • Another study found that when compared to HIV-negative people carefully matched to have similar traditional stroke risk factors, HIV-positive individuals without prior cardiovascular disease had an increased prevalence of carotid plaque, as well as an increased incidence of stroke and transient ischaemic attacks (TIAs) that produce stroke-like symptoms for less than 24 hours.