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.
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Acknowledgments
The authors thank Ms. Rubab Hassan, BSc, formerly of the Department of Biostatistics and Clinical Epidemiology, Perelman School of Medicine, University of Pennsylvania, for her assistance with preparation of the tables.
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The authors declare that they have no conflict of interest.
Funding
Canadian Institute of Health Research HIV/AIDS priority fellowship grant (FJM).
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Thakur, K.T., Lyons, J.L., Smith, B.R. et al. Stroke in HIV-infected African Americans: a retrospective cohort study. J. Neurovirol. 22, 50–55 (2016). https://doi.org/10.1007/s13365-015-0363-x
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DOI: https://doi.org/10.1007/s13365-015-0363-x