title: A meta-analysis investigating incidence and features of stroke in HIV-infected patients in the highly active antiretroviral therapy era.
abstract: OBJECTIVE
  Recent studies have suggested a close biological and clinical association between HIV infection and risk of myocardial infarction, whereas contrasting data have been reported about incidence of stroke and its clinical predictors.
  
  
  METHODS
  Studies including HIV-infected patients developing a cerebral ischemic event were systematically searched for in MEDLINE/PubMed.
  
  
  METHODS
  Baseline, treatment and outcome data were appraised and pooled with random-effects methods computing summary estimates (95% confidence intervals).
  
  
  RESULTS
  Five studies comprising 89,713 participants were included: they were young [46 (46-50) years, mainly male (70% (68-79)] with a moderate prevalence of diabetes [19% (14-21)]. Atrial fibrillation and history of previous coronary artery disease were observed in 3% (2-5) and 18% (15-22), respectively. All patients were on highly active antiretroviral therapy (HAART) and had been treated for a mean of 5 (2-6) years. After a median of 4 (3-5) years of follow-up, 1245 ischemic strokes occurred [1.78% (0.75-2.81)]. Traditional risk factors such as age (five studies), hypertension (three studies), smoking (two studies), hyperlipidemia (one study), atrial fibrillation (one study) and diabetes (one study) were identified as independent predictors of stroke. In one study, RNA viral load [log of odds ratio = 1.10 (1.04-1.17)] and CD4+ cell count less than 200/μl were clinically related to stroke, whereas HAART therapy showed a neutral effect.
  
  
  CONCLUSIONS
  Stroke represents a relatively common complication in young, HAART-treated HIV patients. Apart from traditional cardiovascular risk factors, HIV-RNA viral load may help to target and manage patients at risk.
authors: aDivision of Cardiology, University of Turin, Turin bDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy cVCU Pauley Heart Center, Richmond, Virginia, USA dUnit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin eMeta-analysis and Evidence Based Medicine Training in Cardiology (METCARDIO), Ospedaletti, Italy.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Giorgio
authors: G
authors: Quadri
authors: Enrico
authors: E
authors: Cerrato
authors: Andrea
authors: A
authors: Calcagno
authors: Pierluigi
authors: P
authors: Omedè
authors: Walter
authors: W
authors: Grosso Marra
authors: Antonio
authors: A
authors: Abbate
authors: Stefano
authors: S
authors: Bonora
authors: Giuseppe
authors: G
authors: Biondi Zoccai
authors: Claudio
authors: C
authors: Moretti
authors: Fiorenzo
authors: F
authors: Gaita
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000821:virology*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents