Stroke rates up 67 percent for those with HIV

Kathleen Blanchard's picture
Stroke in HIV Patients
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An analysis shows while general stroke rates decline, the incidence for HIV patients has almost tripled. Researchers from Johns Hopkins and University of California - San Diego teamed up to find the dramatic increase in strokes among individuals with HIV.

They also found, compared to most, ischemic type strokes are occurring at a younger age, in the 50’s age group. To find the link, the researchers analyzed admissions from a dataset of hospital admissions for primary diagnosis of stroke between 1997 and 2006.

In the general population, rates of stroke declined 7%, but for HIV positive patients, the rate was 67% higher. In the study, the events were exclusively from lack of blood flow to the brain, or ischemic stroke versus brain hemorrhage.

According to Bruce Ovbiagele, MD, professor of neurosciences at the University of California, San Diego School of Medicine, the findings stand out because strokes in HIV positive patients are not common.

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The study authors note a correlation between high stroke rates and implementation of highly active antiretroviral therapy (HAART) for HIV patients. Ovbiagele said newer data suggests the drugs used to suppress AIDS can be associated with metabolic complications linked to higher risk of stroke.

Patients with HIV are living longer, but Dr. Ovbiagele says the because strokes are occurring in the HIV positive patients in their 50’s, there may be a metabolic link between use of HAART therapy and stroke and perhaps heart attack that should be explored. Antiviral drugs can affect lipids and glucose metabolism, that could account for the spike in ischemic stroke events seen.

He explains, "Stroke risk is highly correlated with increasing age. Almost three-quarters of strokes occur after the age of 65. Indeed, after 55, the risk doubles for each successive decade”, but adds, "Patients on HAART will clearly need to remain on the drugs to extend their lives, but the challenge will be to clarify whether HAART therapy is an innocent bystander or a direct culprit in this process.

Furthermore, it would be helpful to find out if rates of myocardial infarctions, more commonly known as heart attacks, are rising among HIV patients since they share similar underlying biological mechanisms to ischemic strokes."

Dr. Ovbiagele plans to conduct more studies that might explain the almost triple rates of stroke in HIV patients. The researchers note the findings have important socioeconomic implications. The findings show 67 percent increase in stroke rates over the last decade in HIV patients, in sharp contrast to the general population whose rates of stroke have declined 9 percent.

Neurology: January 19, 2011, doi: 10.1212/WNL.0b013e31820a0cfc
"Increasing incidence of ischemic stroke in patients with HIV infection"

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