Predictors of ischemic and hemorrhagic strokes among people living with HIV: The D:A:D International Prospective Multicohort Study. EClinical Medicine
Hatleberg et al. for the Data Collection on Adverse events of anti-HIV Drugs (D:A:D) Study Group aimed to investigate systematically whether hypertension, other common cardiovascular disease (CVD) risk factors and HIV-related factors were differently associated with ischemic and hemorrhagic strokes.
HIV-1-positive individuals were followed from the time of first blood pressure (BP) measurement after 1/1/1999 or study entry until the first of a validated stroke, 6 months after last follow-up or 1/2/2014.
Five-hundred and ninety centrally validated strokes occurred over 339’979 person-years of follow-up. In formal comparison models (83 hemorrhagic and 296 ischemic strokes), they found the strongest common predictors to be hypertension and older age. Male gender, previous cardiovascular events, and smoking were stronger predictors of ischemic strokes, whereas hypertension, hepatitis C virus coinfection and estimated glomerular filtration rate b60 mL/min/1.72m3 were stronger predictors of hemorrhagic strokes. A CD4 count b200 cells/μL was associated with a borderline increased risk of hemorrhagic but not ischemic stroke, whereas a higher viral load and exposure to antiretroviral therapy were not associated with the risk of either stroke subtype.
In conclusion, the risk factor profiles for ischemic and hemorrhagic strokes in people living with HIV (PLWHIV) appear to differ. While the study found no strong evidence to support the need for specific stroke risk prediction scores for PLWHIV, the findings do emphasize the importance of considering stratified stroke risk prediction for the different stroke subtypes to optimize preventive measures and screening. Further studies are needed to confirm these findings in order to provide more precise risk scoring systems in PLWHIV as well as in the general population.