title: Effect of CD4+ cell count and viral suppression on risk of ischemic stroke in HIV infection.
abstract: OBJECTIVE
  Evidence from the current era of combination antiretroviral therapy supports an association between HIV and cerebrovascular disease. In addition to traditional vascular risk factors, HIV-specific factors including immunodeficiency and viral replication may also predict stroke risk. The aim of this study was to determine the relationship between CD4(+) cell count, viral suppression and validated ischemic stroke outcomes.
  
  
  METHODS
  A single-centre, case-control study.
  
  
  METHODS
  We identified ischemic stroke cases in HIV-infected adults from an HIV clinic using International Classification of Diseases codes for cerebrovascular disease followed by validation of each case. Controls from the same HIV clinic were selected by incidence density sampling. Demographic and clinical data, including the most recent CD4(+) cell count and plasma HIV RNA concentration, were abstracted from hospital and HIV clinic electronic medical records. Matched conditional logistic regression models were used to evaluate the association between CD4(+) cell count, viral suppression and ischemic stroke.
  
  
  RESULTS
  In an adjusted model, viral suppression decreased the odds of ischemic stroke by a factor of 0.16 [95% confidence interval (95% CI) 0.05-0.50, P = 0.002]. This association, although attenuated [odds ratio (OR) 0.31, 95% CI 0.09-1.06, P = 0.062], remained after restricting the analysis to ischemic strokes due to true atherosclerotic mechanisms (i.e. excluding infection and malignancy-related strokes).
  
  
  CONCLUSIONS
  Achieving viral suppression may reduce ischemic stroke risk, including risk of atherosclerotic strokes, in HIV-infected individuals.
authors.affiliation: aDepartment of Neurology bDepartment of Epidemiology and Biostatistics cDepartment of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Chow
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
authors.forename: Richard W
authors.initials: RW
authors.lastname: Price
authors.forename: Priscilla Y
authors.initials: PY
authors.lastname: Hsue
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D019562:Viral Load