BACKGROUND: We studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage. METHODS: We performed a cohort and nested case control study in an administrative database. We selected all HIV-positive individuals presenting between 1985 and 2007. Each HIV-positive subject was matched with 4 HIV-negative individuals. We used a Poisson regression model to calculate rates of intracranial hemorrhage according to HIV status. We conducted a case -control study nested within the cohort of HIV-positive individuals to look at the effect of antiretroviral medications. Odds ratios for antiretroviral exposure were obtained using conditional logistic regression. RESULTS: There were 7,053 HIV-positive and 27,681 HIV-negative subjects, representing 138,704 person-years. There were 49 incident intracranial hemorrhages, 29 in HIV-positive and 20 in HIV-negative individuals. The adjusted hazard ratio for intracranial hemorrhage in HIV-positive compared to HIV-negative patients was 3.28 (95% confidence interval [CI] 1.75-6.12). The effect was reduced to 1.99 (95% CI 0.92-4.31) in the absence of AIDS-defining conditions, and increased to 7.64 (95% CI 3.78-15.43) in subjects with AIDS-defining conditions. Hepatitis C infection, illicit drug or alcohol abuse, intracranial lesions, and coagulopathy were all strongly associated with intracranial hemorrhage (all P < .001). In the case control study, 29 cases of ICH in HIV-positive individuals were matched to 228 HIV-positive controls. None of the antiretroviral classes were associated with an increase in the odds ratio of intracranial hemorrhage. CONCLUSIONS: The risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage.
BACKGROUND: We studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage. METHODS: We performed a cohort and nested case control study in an administrative database. We selected all HIV-positive individuals presenting between 1985 and 2007. Each HIV-positive subject was matched with 4 HIV-negative individuals. We used a Poisson regression model to calculate rates of intracranial hemorrhage according to HIV status. We conducted a case -control study nested within the cohort of HIV-positive individuals to look at the effect of antiretroviral medications. Odds ratios for antiretroviral exposure were obtained using conditional logistic regression. RESULTS: There were 7,053 HIV-positive and 27,681 HIV-negative subjects, representing 138,704 person-years. There were 49 incident intracranial hemorrhages, 29 in HIV-positive and 20 in HIV-negative individuals. The adjusted hazard ratio for intracranial hemorrhage in HIV-positive compared to HIV-negative patients was 3.28 (95% confidence interval [CI] 1.75-6.12). The effect was reduced to 1.99 (95% CI 0.92-4.31) in the absence of AIDS-defining conditions, and increased to 7.64 (95% CI 3.78-15.43) in subjects with AIDS-defining conditions. Hepatitis C infection, illicit drug or alcohol abuse, intracranial lesions, and coagulopathy were all strongly associated with intracranial hemorrhage (all P < .001). In the case control study, 29 cases of ICH in HIV-positive individuals were matched to 228 HIV-positive controls. None of the antiretroviral classes were associated with an increase in the odds ratio of intracranial hemorrhage. CONCLUSIONS: The risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage.
Authors: Felicia C Chow; Wei He; Peter Bacchetti; Susan Regan; Steven K Feske; James B Meigs; Steven K Grinspoon; Virginia A Triant Journal: Neurology Date: 2014-10-03 Impact factor: 9.910
Authors: Réza Behrouz; Christopher Hans Topel; Ali Seifi; Lee A Birnbaum; Robin L Brey; Vivek Misra; Mario Di Napoli Journal: J Neurovirol Date: 2016-04-04 Impact factor: 2.643
Authors: Barbara N Harding; Tigran Avoundjian; Susan R Heckbert; Bridget M Whitney; Robin M Nance; Stephanie A Ruderman; Rizwan Kalani; David L Tirschwell; Emily L Ho; Kyra J Becker; Joseph Zunt; Felicia Chow; Andrew Huffer; W Christopher Mathews; Joseph Eron; Richard D Moore; Christina M Marra; Greer Burkholder; Michael S Saag; Mari M Kitahata; Heidi M Crane; Joseph C Delaney Journal: Epidemiology Date: 2021-05-01 Impact factor: 4.860