Stroke in HIV-infected African Americans: a retrospective cohort study

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• 作者：Kiran T. Thakur ; Jennifer L. Lyons ; Bryan R. Smith…
• 关键词：Stroke ; African American ; Human immunodeficiency virus ; Disparity ; United States
• 刊名：Journal of NeuroVirology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：22
• 期：1
• 页码：50-55
• 全文大小：282 KB
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• 作者单位：Kiran T. Thakur (1)
  Jennifer L. Lyons (2) (3)
  Bryan R. Smith (4)
  Russell T. Shinohara (5)
  Farrah J. Mateen (2) (6)
  
  1. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, USA
  2. Harvard Medical School, Boston, MA, USA
  3. Division of Neuroinfectious Diseases, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
  4. Section of Infections of the Nervous System, National Institute for Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
  5. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
  6. Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA
  
• 刊物主题：Neurosciences; Virology; Infectious Diseases; Immunology; Neurology;
• 出版者：Springer US
• ISSN：1538-2443

文摘

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. Keywords Stroke African American Human immunodeficiency virus Disparity United States