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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
- 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
- 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.