Stroke and HIV‐associated neurological complications: A retrospective nationwide study

Abstract

There is an increased risk of stroke and other neurological complications in human immunodeficiency virus (HIV) infected patients with no large population‐based studies in the literature. We aim to evaluate the prevalence of stroke, HIV‐associated neurological complications, and identify risk factors associated with poor outcomes of stroke among HIV admissions in the United States. In the nationwide inpatient sample with adult HIV hospitalizations, patients with primary cerebrovascular disease (CeVDs) and HIV‐associated neurological complications were identified by ICD‐9‐CM codes. We performed a retrospective study with weighted analysis to evaluate the prevalence of stroke and neurological complications and outcomes of stroke among HIV patients. We included 1,559,351 HIV admissions from 2003 to 2014, of which 22470 (1.4%) patients had CeVDs (transient ischemic attack [TIA]: 3240 [0.2%], acute ischemic stroke [AIS]: 14895 [0.93%], and hemorrhagic stroke [HS]: 4334 [0.27%]), 7781 (0.49%) had neurosyphilis, 29,925 (1.87%) meningitis, 39,190 (2.45%) cytomegalovirus encephalitis, 4699 (0.29%) toxoplasmosis, 9964 (0.62%) progressive multifocal leukoencephalopathy, and 142,910 (8.94%) epilepsy. There is increased overall prevalence trend for CeVDs (TIA: 0.17%–0.24%; AIS: 0.62%–1.29%; HS: 0.26%–0.31%; pTrend\u2009<\u2009.0001) from 2003 to 2014. Among HIV admissions, variables associated with AIS were neurosyphilis (odds ratio: 4.38; 95% confidence interval: 3.21–5.97), meningitis (4.87 [4.10–5.79]), and central nervous system tuberculosis (6.72 [3.85–11.71]). Toxoplasmosis [4.27 [2.34–7.76]), meningitis (2.91 [2.09–4.06)], and cytomegalovirus encephalitis (1.62 [1.11–2.37]) were associated with higher odds of HS compared to patients without HS. There was an increasing trend of CeVDs over time among HIV hospitalizations. HIV‐associated neurological complications were associated with the risk of stroke, together with increased mortality, morbidity, disability, and discharge to long‐term care facilities. Further research would clarify stroke risk factors in HIV patients to mitigate adverse outcomes.