title: Cerebrovascular events in HIV-infected patients: an analysis of a cohort of 3203 HIV+ patients during the times of cART.
abstract: OBJECTIVE
  Cerebrovascular events (CVE) in HIV infected patients have become an increasingly relevant neurological complication. Data about the prevalence and clinical features of CVE in HIV infected patients since the introduction of combined Anti-Retroviral Therapy (cART) are rare.
  
  
  METHODS
  A retrospective study of HIV-infected patients with a CVE was performed from 2002 to 2011. During this time period 3203 HIV-infected patients were admitted to the University hospital of Münster, Germany. All patients had access to regular and long term treatment with cART. The clinical features were analyzed and the prevalence of ischemic stroke (IS), transient ischemic attack (TIA) and intracerebral bleeding (ICB) was calculated.
  
  
  RESULTS
  The total prevalence of all CVE was at 0.6% (95% CI: 0.3, 0.8) (0.4% for IS (95% CI: 0.2, 0.6), 0.2% for TIA (95% CI: 0.0, 0.3) and 0.1% for ICB (95% CI: 0.0, 0.2)) and the crude annual incidence rate at 59 per 100.000 for all events. The median CD4 cell count was 405/μl (25th to 75th percentile: 251-568). The majority of patients had AIDS. The median age was at 49 years (25th to 75th percentile: 40-69). Some events were associated with HIV-associated vasculopathy or viral co-infections. Most patients presented with multiple vascular risk factors.
  
  
  CONCLUSIONS
  The study confirms that CVE occur in HIV-infected patients with a good immune status and at a young age. HIV infection has to be considered in young stroke patients. The rate of CVE in this study was constant when comparing to the pre-cART era. HIV associated vasculopathy and viral co-infections need to be considered in the diagnostics of stroke.
authors.affiliation: 1Department of Neurology, University of Münster, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Arentzen
authors.forename: Franziska
authors.initials: F
authors.lastname: Jubt
authors.forename: Stefan
authors.initials: S
authors.lastname: Evers
authors.forename: Volker
authors.initials: V
authors.lastname: Hesselmann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fiori
authors.forename: Doris
authors.initials: D
authors.lastname: Reichelt
authors.forename: Ute
authors.initials: U
authors.lastname: Oelker-Grueneberg
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schwindt
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
authors.forename: Ingo-W
authors.initials: IW
authors.lastname: Husstedt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D018791:CD4 Lymphocyte Count; D002561:Cerebrovascular Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005858:Germany; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: AIDS; HIV; HIV vasculopathy; TIA; cART; cerebrovascular disease; stroke