Ischaemic Stroke in HIV-Infected Patients

A Case-Control Study

A Silva-Pinto; A Costa; R Serrão; A Sarmento; P Abreu


HIV Medicine. 2017;18(3):214-219. 

In This Article

Abstract and Introduction


Objectives The aim of the study was to provide insights into the contributions of HIV infection stage, antiretroviral therapy (ART) and vascular risk factors to the occurrence of ischaemic stroke in HIV-infected patients.

Methods We performed a case–control study of HIV-infected patients followed in our clinic. We compared patients hospitalized between January 2006 and June 2014 with an ischaemic stroke or transient ischaemic attack to age- and gender-matched controls without stroke.

Results Of 2146 patients followed in our clinic, we included 23 cases (20 men and three women; mean age 51.3 years) and 23 controls. Eighty-three per cent of cases had had a stroke and 17% a transient ischaemic attack. According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, small-vessel occlusion was the most frequent aetiology, followed by large-artery atherosclerosis and cardioembolism. Compared with controls, stroke was statistically significantly associated with diabetes, smoking and low concentrations of high-density lipoprotein (HDL) cholesterol. Illegal drug use, a low CD4 count and a high viral load were also associated with ischaemic cerebral events. There were no statistically significant differences between cases and controls in Centers for Disease Control and Prevention (CDC) HIV stage, CD4 count nadir and HIV infection time-to-event. No statistically significant differences were found concerning ART or treatment compliance.

Conclusions In our single centre study, we found associations of illegal drug use, HIV replication and some traditional vascular risk factors with the occurrence of ischaemic cerebral events. The paradigm of the care of HIV-infected patients is changing. Concomitant diseases in the ageing patient with HIV infection, including cerebrovascular disease, must also be addressed in view of their impacts on morbidity and mortality. Apart from controlling the HIV infection and immunosuppression with ART, vascular risk factors must also be addressed.


In the HIV-infected population, ischaemic cerebral events, including ischaemic stroke and transient ischaemic attacks (TIAs), have mainly been investigated in younger patients with AIDS before the implementation of antiretroviral therapy (ART).[1,2] The most common identified culprits responsible for ischaemic stroke and TIAs were infections, vasculopathy and prothrombotic status.[1–3]

HIV-infected patients are now ageing.[4,5] In addition to HIV infection, traditional vascular risk factors and ART toxicity may contribute to the risk of ischaemic stroke.[6,7] As a consequence, HIV infection and its treatment as well as its interaction with vascular risk factors may contribute to the cause of stroke and affect its clinical presentation and management.[8]

Our main objective was to provide insights into the contributions of HIV infection stage, ART and vascular risk factors to the occurrence of ischaemic stroke or TIA in ageing HIV-infected patients.