title: Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study.
abstract: BACKGROUND
  We studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage.
  
  
  METHODS
  We performed a cohort and nested case control study in an administrative database. We selected all HIV-positive individuals presenting between 1985 and 2007. Each HIV-positive subject was matched with 4 HIV-negative individuals. We used a Poisson regression model to calculate rates of intracranial hemorrhage according to HIV status. We conducted a case -control study nested within the cohort of HIV-positive individuals to look at the effect of antiretroviral medications. Odds ratios for antiretroviral exposure were obtained using conditional logistic regression.
  
  
  RESULTS
  There were 7,053 HIV-positive and 27,681 HIV-negative subjects, representing 138,704 person-years. There were 49 incident intracranial hemorrhages, 29 in HIV-positive and 20 in HIV-negative individuals. The adjusted hazard ratio for intracranial hemorrhage in HIV-positive compared to HIV-negative patients was 3.28 (95% confidence interval [CI] 1.75-6.12). The effect was reduced to 1.99 (95% CI 0.92-4.31) in the absence of AIDS-defining conditions, and increased to 7.64 (95% CI 3.78-15.43) in subjects with AIDS-defining conditions. Hepatitis C infection, illicit drug or alcohol abuse, intracranial lesions, and coagulopathy were all strongly associated with intracranial hemorrhage (all P < .001). In the case control study, 29 cases of ICH in HIV-positive individuals were matched to 228 HIV-positive controls. None of the antiretroviral classes were associated with an increase in the odds ratio of intracranial hemorrhage.
  
  
  CONCLUSIONS
  The risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage.
authors.affiliation: Internal Medicine Service, Centre Hospitalier de l'Univsersité de Montréal (CHUM), Montréal, Québec, Canada. Electronic address: madeleine.durand.chum@ssss.gouv.qc.ca.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Durand
authors.forename: Odile
authors.initials: O
authors.lastname: Sheehy
authors.forename: Jean-Guy
authors.initials: JG
authors.lastname: Baril
authors.forename: Jacques
authors.initials: J
authors.lastname: LeLorier
authors.forename: Cécile L
authors.initials: CL
authors.lastname: Tremblay
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012306:Risk