Types of Stroke Among People Living With HIV in the United States

J Acquir Immune Defic Syndr. 2021 Apr 15;86(5):568-578. doi: 10.1097/QAI.0000000000002598.


Background: Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes.

Setting: CNICS, a U.S. multisite clinical cohort of PLWH in care.

Methods: We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort.

Results: Among 26,514 PLWH, there were 401 strokes, 75% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20%), large vessel atherosclerosis (13%), and small vessel (24%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes.

Conclusion: Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Atherosclerosis / complications
  • Atherosclerosis / epidemiology
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Female
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • Humans
  • Hypertension / complications
  • Hypertension / epidemiology
  • Male
  • Middle Aged
  • Risk Factors
  • Stroke / complications*
  • Stroke / epidemiology*
  • United States / epidemiology