Yung-Feng Yen1, Marcelo Chen, Ian Jen, Yu-Ching Lan, Pei-Hung Chuang, Yen-Ling Liu, Yun Lee, Yi-Ming Arthur Chen. 1. *Department of Internal Medicine, Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; †School of Medicine, National Yang-Ming University, Taipei, Taiwan; ‡Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan; §Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan; ‖Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; ¶Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; #Department of Health Risk Management, China Medical University, Taichung, Taiwan; **Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; ††Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and ‡‡Department of Microbiology and Institute of Medical Research, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Abstract
BACKGROUND: HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. METHODS: We identified adults with HIV infection in 2000-2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A time-dependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV. RESULTS: Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95% CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95% CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95% CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95% CI: 1.37 to 5.67), and Penicillium marneffei infection (AHR 2.90; 95% CI: 1.16 to 7.28). CONCLUSIONS: Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.
BACKGROUND:HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. METHODS: We identified adults with HIV infection in 2000-2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A time-dependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV. RESULTS: Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95% CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95% CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95% CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95% CI: 1.37 to 5.67), and Penicillium marneffeiinfection (AHR 2.90; 95% CI: 1.16 to 7.28). CONCLUSIONS:Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.
Authors: Andréa Gurgel Batista Leite; José E Vidal; Francisco Bonasser Filho; Roberta Schiavon Nogueira; Augusto César Penalva de Oliveira Journal: Braz J Infect Dis Date: 2004-09-08 Impact factor: 1.949
Authors: Laura A Benjamin; Alan Bryer; Hedley C A Emsley; Saye Khoo; Tom Solomon; Myles D Connor Journal: Lancet Neurol Date: 2012-10 Impact factor: 44.182
Authors: R Bijker; A Jiamsakul; E Uy; N Kumarasamy; R Ditango; R Chaiwarith; W W Wong; A Avihingsanon; L P Sun; E Yunihastuti; S Pujari; C D Do; T P Merati; P Kantipong; K V Nguyen; A Kamarulzaman; F Zhang; M P Lee; J Y Choi; J Tanuma; O T Ng; Blh Sim; J Ross; S Kiertiburanakul Journal: HIV Med Date: 2019-01-08 Impact factor: 3.180
Authors: Rimke Bijker; Nagalingeswaran Kumarasamy; Sasisopin Kiertiburanakul; Sanjay Pujari; Wilson Lam; Romanee Chaiwarith; Wing W Wong; Adeeba Kamarulzaman; Pacharee Kantipong; Anchalee Avihingsanon; Kinh V Nguyen; Junko Tanuma; Oon Tek Ng; Benedict Lh Sim; Tuti P Merati; Jun Y Choi; Rossana Ditangco; Evy Yunihastuti; Ly P Sun; Cuong D Do; Jeremy Ross; Matthew Law Journal: Antivir Ther Date: 2019
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
Authors: Harriet J Forbes; Laura Benjamin; Judy Breuer; Martin M Brown; Sinéad M Langan; Caroline Minassian; Liam Smeeth; Sara L Thomas; Charlotte Warren-Gash Journal: BMJ Open Date: 2017-05-29 Impact factor: 2.692
Authors: Lewis J Haddow; Carole H Sudre; Magdalena Sokolska; Richard C Gilson; Ian G Williams; Xavier Golay; Sebastien Ourselin; Alan Winston; Caroline A Sabin; M Jorge Cardoso; H Rolf Jäger Journal: AIDS Res Hum Retroviruses Date: 2019-02-20 Impact factor: 2.205