title: Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults.
abstract: OBJECTIVE
  To our knowledge there are no studies reporting the use and short-term outcomes of intravenous tissue plasminogen activator (IV-TPA) for the treatment of acute ischaemic stroke (AIS) in people living with HIV.
  
  
  METHODS
  The US Nationwide Inpatient Sample (NIS) (2006-2010) was searched for HIV-infected AIS patients treated with IV-TPA.
  
  
  RESULTS
  In the NIS, 2.2% (62/2877) of HIV-infected AIS cases were thrombolyzed with IV-TPA (median age 52 years, range 27-78, 32% female, 22% Caucasian) vs. 2.1% (19 335/937 896) of HIV-uninfected cases (median age 72 years, range 17-102 years, 50% female, 74% Caucasian; P = 0.77). There were more deaths in HIV-infected versus uninfected patients with stroke (220/2877, 7.6% vs. 49 089/937 547, 5.2%, P < 0.001) but no difference in the proportion of deaths amongst IV-TPA-treated patients. The age- and sex-adjusted odds ratio for death following IV-TPA administration in HIV-infected versus uninfected patients was 2.26 (95% CI 1.12, 4.58), but the interaction on mortality between HIV and IV-TPA use was not statistically significant, indicating no difference in risk of in-hospital death by HIV serostatus with IV-TPA use. A higher number of HIV-infected patients remained in hospital versus died or were discharged at both 10 and 30 days (P < 0.01 at 10 and 30 days). No difference in the proportion of intracerebral hemorrhage in the two groups was found (P = 0.362).
  
  
  CONCLUSIONS
  The in-hospital mortality is higher amongst HIV-infected AIS patients than HIV-uninfected patients. However, the risk of death amongst HIV-infected patients treated with IV-TPA is similar to HIV-uninfected groups.
authors.affiliation: Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Sweeney
authors.forename: K T
authors.initials: KT
authors.lastname: Thakur
authors.forename: J L
authors.initials: JL
authors.lastname: Lyons
authors.forename: B R
authors.initials: BR
authors.lastname: Smith
authors.forename: J Z
authors.initials: JZ
authors.lastname: Willey
authors.forename: A M
authors.initials: AM
authors.lastname: Cervantes-Arslanian
authors.forename: M K
authors.initials: MK
authors.lastname: Hickey
authors.forename: K
authors.initials: K
authors.lastname: Uchino
authors.forename: D C
authors.initials: DC
authors.lastname: Haussen
authors.forename: S
authors.initials: S
authors.lastname: Koch
authors.forename: L H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: M S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: R T
authors.initials: RT
authors.lastname: Shinohara
authors.forename: F J
authors.initials: FJ
authors.lastname: Mateen
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000494:pharmacology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator
keywords: HIV; cerebral infarction; cerebrovascular diseases and cerebral circulation; infections; neurological disorders; stroke; thrombolysis