Greater Risk of Stroke of Undetermined Etiology in a Contemporary HIV-Infected Cohort Compared with Uninfected Individuals

Abstract

Although ischemic stroke risk is increased among people living with HIV infection, little is known about the epidemiology of ischemic stroke subtypes in contemporary HIV-infected cohorts. We examined the distribution of ischemic stroke subtypes among predominantly treated HIV-infected individuals to determine if and how the distribution differs from that of the general population. We studied 60 HIV-infected and 60 HIV-uninfected adults with a history of first-ever ischemic stroke between 2000 and 2012. Ischemic strokes were classified as 1 of 5 subtypes based on established criteria. We used multinomial logistic regression models to compare the relative frequency of ischemic stroke subtypes by HIV status. Large artery atherosclerosis (23%) and stroke of undetermined etiology (23%) were the most common stroke subtypes among HIV-infected individuals. The most recent plasma HIV viral load before the stroke event differed by subtype, with a median undetectable viral load for individuals with large artery stroke and stroke of undetermined etiology. Using cardioembolic stroke as the reference subtype, HIV-infected individuals were at higher proportional risk of stroke of undetermined etiology compared with uninfected individuals (relative risk ratio [RRR]: 8.6, 95% confidence interval [CI]: 1.2-63.7, P = .04). Among HIV-infected individuals with virologically suppressed infection, we observed a trend toward a greater proportion of strokes attributable to large artery atherosclerosis (RRR: 6.7, 95% CI: .8-57.9, P = .08). HIV-infected individuals may be at greater proportional risk of stroke of undetermined etiology compared with uninfected individuals. Further investigation is warranted to confirm this finding and determine underlying reasons for this greater risk.