Effect of CD4+ cell count and viral suppression on risk of ischemic stroke in HIV infection.
Effect of CD4+ cell count and viral suppression on risk of ischemic stroke in HIV infection.
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DOI：
10.1097/qad.0000000000000452
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发表时间：
2014-11-13
期刊：
影响因子：
--
通讯作者：
Hsue PY
中科院分区：
文献类型：
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作者：
Chow FC;Bacchetti P;Kim AS;Price RW;Hsue PY
Evidence from the current era of combination antiretroviral therapy supports an association between HIV and cerebrovascular disease. In addition to traditional vascular risk factors, HIV-specific factors including immunodeficiency and viral replication may also predict stroke risk. The aim of this study was to determine the relationship between CD4 cell count, viral suppression and validated ischemic stroke outcomes. Single-center, case-control study We identified ischemic stroke cases in HIV-infected adults from an HIV clinic using International Classification of Diseases codes for cerebrovascular disease followed by validation of each case. Controls from the same HIV clinic were selected by incidence density sampling. Demographic and clinical data, including most recent CD4 count and plasma HIV RNA concentration, were abstracted from hospital and HIV clinic electronic medical records. Matched conditional logistic regression models were used to evaluate the association between CD4 cell count, viral suppression and ischemic stroke. In an adjusted model, viral suppression decreased the odds of ischemic stroke by a factor of 0.16 (95% CI 0.05-0.50, p=0.002). This association, although attenuated (OR 0.31, 95% CI 0.09-1.06, p=0.062), remained after restricting the analysis to ischemic strokes due to true atherosclerotic mechanisms (i.e., excluding infection and malignancy-related strokes). Achieving viral suppression may reduce ischemic stroke risk, including risk of atherosclerotic strokes, in HIV-infected individuals.
