Stroke and HIV infection.

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To the Editor: We read with interest the report by Mochan et al1 regarding stroke in HIV-infected patients. This is an exceedingly relevant issue, given that both entities are common and the management of patients in whom both problems coincide is uncertain. The annual incidence rate of ischemic stroke in HIV was 216 per 100 000 in a large cohort, which is less than the stroke incidence of the whole population (>240 per 100 000 in the United States).2 However, stroke becomes more common in immunocompromised patients, particularly those with opportunistic central nervous system infections.2 Other important causes of stroke in HIV-infected patients are consequence of concomitant social issues rather than the effects of HIV itself, predominantly illicit drug use.3 Cocaine use, in particular, is a notorious factor associated with stroke in our community. Nevertheless, Mochan and colleagues did not include in their cohort patients with a history of intravenous or other illicit drug use. Other possible causes of stroke include infective endocarditis, meningovascular syphilis, injection injury to the carotid arteries, and secondary antiphospholipid antibody syndrome. In our view, physicians caring for HIV-infected individuals with stroke need to formulate 2 important questions: (1) Is a spinal tap indicated, and (2) does the patient have a coagulopathy? Mochan et al reported a cohort of 33 patients with cerebral infarction and 2 with primary intracerebral hemorrhage. Almost all patients had a lumbar puncture and coagulopathy workup. Most patients were young, with mean age of 32 years. …