title: Risk of intracerebral hemorrhage in HIV/AIDS: a systematic review and meta-analysis.
abstract: Evidence for the association and the increased risk of stroke with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is growing. Recent studies have reported on HIV infection as a potent risk factor for intracerebral hemorrhage (ICH). We used the pooled results from case-control studies to conduct a systematic review and a meta-analysis in order to evaluate the risk of ICH with HIV/AIDS. Our systematic review and meta-analysis was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm of all available case-control studies that reported on the risk of ICH in patients with HIV/AIDS. Five eligible studies were identified, totaling 5,310,426 person-years studied over various periods that ranged from 1985 to 2010. There were a total of 724 cases of ICH, 138 with HIV/AIDS. HIV-infected ICH patients were in average younger. Pooled crude incidence rate ratio (IRR) for ICH in HIV/AIDS patients was 3.40 (95 % confidence intervals [CI] 1.44-8.04; p = 0.005, random-effects model). Clinical AIDS was associated with a higher IRR of ICH (11.99, 95 % CI 2.84-50.53; p = 0.0007) than HIV+ status without AIDS (1.73, 95 % CI 1.39-2.16; p < 0.0001). Patients with CD4+lymphocyte count <200 cells/mm3were similarly at a higher risk. Antiretroviral therapy did not seem to increase the risk of ICH. The available evidence suggests that HIV/AIDS is an important risk factor for ICH, particularly in younger HIV-infected patients and those with advanced disease.
authors.affiliation: Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA. behrouz@uthscsa.edu.|Department of Neurology, Medical Arts and Research Center, University of Texas Health Science Center San Antonio, 8300 Floyd Curl Drive, MC 7883, San Antonio, TX, 78229, USA. behrouz@uthscsa.edu.
authors.forename: Réza
authors.initials: R
authors.lastname: Behrouz
authors.affiliation: Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Christopher Hans
authors.initials: CH
authors.lastname: Topel
authors.affiliation: Department of Neurological Surgery, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Seifi
authors.affiliation: Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.|Department of Neurological Surgery, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Birnbaum
authors.affiliation: Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Brey
authors.affiliation: Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Misra
authors.affiliation: Neurological Service, San Camillo de' Lellis General Hospital, Rieti and the Neurological Section, Neuro-epidemiology Unit, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Di Napoli
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
chemical_list: D019380:Anti-HIV Agents
keywords: Acquired immunodeficiency syndrome; Human immunodeficiency virus; Intracerebral hemorrhage; Meta-analysis; Stroke