Risk of intracerebral hemorrhage in HIV/AIDS: a systematic review and meta-analysis

J Neurovirol. 2016 Oct;22(5):634-640. doi: 10.1007/s13365-016-0439-2. Epub 2016 Apr 4.


Evidence for the association and the increased risk of stroke with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is growing. Recent studies have reported on HIV infection as a potent risk factor for intracerebral hemorrhage (ICH). We used the pooled results from case-control studies to conduct a systematic review and a meta-analysis in order to evaluate the risk of ICH with HIV/AIDS. Our systematic review and meta-analysis was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm of all available case-control studies that reported on the risk of ICH in patients with HIV/AIDS. Five eligible studies were identified, totaling 5,310,426 person-years studied over various periods that ranged from 1985 to 2010. There were a total of 724 cases of ICH, 138 with HIV/AIDS. HIV-infected ICH patients were in average younger. Pooled crude incidence rate ratio (IRR) for ICH in HIV/AIDS patients was 3.40 (95 % confidence intervals [CI] 1.44-8.04; p = 0.005, random-effects model). Clinical AIDS was associated with a higher IRR of ICH (11.99, 95 % CI 2.84-50.53; p = 0.0007) than HIV+ status without AIDS (1.73, 95 % CI 1.39-2.16; p < 0.0001). Patients with CD4+ lymphocyte count <200 cells/mm3 were similarly at a higher risk. Antiretroviral therapy did not seem to increase the risk of ICH. The available evidence suggests that HIV/AIDS is an important risk factor for ICH, particularly in younger HIV-infected patients and those with advanced disease.

Keywords: Acquired immunodeficiency syndrome; Human immunodeficiency virus; Intracerebral hemorrhage; Meta-analysis; Stroke.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Case-Control Studies
  • Cerebral Hemorrhage / complications
  • Cerebral Hemorrhage / diagnosis*
  • Cerebral Hemorrhage / pathology
  • Cerebral Hemorrhage / virology
  • Disease Progression
  • Female
  • HIV Infections / complications
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / pathology
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Stroke / complications
  • Stroke / diagnosis*
  • Stroke / pathology
  • Stroke / virology


  • Anti-HIV Agents