Stroke in HIV-infected African Americans: a retrospective cohort study

The risk of having a first stroke is nearly twice as high among African Americans compared to Caucasians. HIV/AIDS is an independent risk factor for stroke. Our study aimed to report the risk factors and short-term clinical outcomes of African Americans with HIV infection and new-onset stroke admitted at the Johns Hopkins Hospitals (2000–2012). Multivariate linear regression was used to examine the association between potential predictors and odds of an unfavorable outcome, defined as a higher modified Rankin Scale (mRS) score on hospital discharge. African Americans comprised 105/125 (84 %) of HIV-infected new-onset stroke inpatients (median age 50 years; 69 % men; median CD4 140/mL; ischemic 77 %; 39 % taking highly active antiretroviral therapy). Vascular risk factors were common: hypertension (67 %), cigarette smoking (66 %), dyslipidemia (42 %), hepatitis C (48 %), intravenous drug abuse (32 %), and prior myocardial infarction (29 %). Prior aspirin and statin use were uncommon (18 %, 9 %). Unfavorable outcome (mRS score 4–6, n = 22 of 90 available records) was noted in 24 % of patients, including seven in-hospital deaths. On multivariate analyses, higher CD4 count on hospital admission was associated with a lower mRS (−0.2 mRS points per 1 unit increase in CD4, 95 % CI (−0.3, 0), p = 0.03). Intracerebral hemorrhage was also associated with a lower mRS (1.0 points lower, 95 % CI (0.2, 1.8) compared to ischemic stroke, p = 0.01) after adjustment for other potential predictors. This underscores the importance of HIV infection on functional stroke outcomes beyond its recognized influence on stroke risk.