title: Stroke in HIV-infected African Americans: a retrospective cohort study.
abstract: The risk of having a first stroke is nearly twice as high among African Americans compared to Caucasians. HIV/AIDS is an independent risk factor for stroke. Our study aimed to report the risk factors and short-term clinical outcomes of African Americans with HIV infection and new-onset stroke admitted at the Johns Hopkins Hospitals (2000-2012). Multivariate linear regression was used to examine the association between potential predictors and odds of an unfavorable outcome, defined as a higher modified Rankin Scale (mRS) score on hospital discharge. African Americans comprised 105/125 (84%) of HIV-infected new-onset stroke inpatients (median age 50 years; 69% men; median CD4 140/mL; ischemic 77%; 39% taking highly active antiretroviral therapy). Vascular risk factors were common: hypertension (67%), cigarette smoking (66%), dyslipidemia (42%), hepatitis C (48%), intravenous drug abuse (32%), and prior myocardial infarction (29%). Prior aspirin and statin use were uncommon (18%, 9%). Unfavorable outcome (mRS score 4-6, n = 22 of 90 available records) was noted in 24% of patients, including seven in-hospital deaths. On multivariate analyses, higher CD4 count on hospital admission was associated with a lower mRS (-0.2 mRS points per 1 unit increase in CD4, 95% CI (-0.3, 0), p = 0.03). Intracerebral hemorrhage was also associated with a lower mRS (1.0 points lower, 95% CI (0.2, 1.8) compared to ischemic stroke, p = 0.01) after adjustment for other potential predictors. This underscores the importance of HIV infection on functional stroke outcomes beyond its recognized influence on stroke risk.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, USA. ktt2115@cumc.columbia.edu.
authors.forename: Kiran T
authors.initials: KT
authors.lastname: Thakur
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Division of Neuroinfectious Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Lyons
authors.affiliation: Section of Infections of the Nervous System, National Institute for Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Smith
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
authors.affiliation: Harvard Medical School, Boston, MA, USA. fmateen@partners.org.|Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA. fmateen@partners.org.
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000473:pathology / Q000821:virology; D050171:Dyslipidemias / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D006526:Hepatitis C / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000503:physiopathology; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D015819:Substance Abuse, Intravenous / Q000503:physiopathology
chemical_list: D019380:Anti-HIV Agents
keywords: African American; Disparity; Human immunodeficiency virus; Stroke; United States