Types of Stroke Among People Living With HIV in the United States. Crane, H. M., Nance, R. M., Avoundjian, T., Harding, B. N., Whitney, B. M., Chow, F. C., Becker, K. J., Marra, C. M., Zunt, J. R., Ho, E. L., Kalani, R., Huffer, A., Burkholder, G. A., Willig, A. L., Moore, R. D., Mathews, W. C., Eron, J. J., Napravnik, S., Lober, W. B., Barnes, G. S., McReynolds, J., Feinstein, M. J., Heckbert, S. R., Saag, M. S., Kitahata, M. M., Delaney, J. A. C., & Tirschwell, D. L. JAIDS Journal of Acquired Immune Deficiency Syndromes, 86(5):568–578, April, 2021.
Types of Stroke Among People Living With HIV in the United States [link]Paper  doi  abstract   bibtex   
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.
@article{crane_types_2021,
	title = {Types of {Stroke} {Among} {People} {Living} {With} {HIV} in the {United} {States}},
	volume = {86},
	issn = {1525-4135},
	url = {https://journals.lww.com/jaids/Fulltext/2021/04150/Types_of_Stroke_Among_People_Living_With_HIV_in.11.aspx?casa_token=jOkwzWWCmawAAAAA:V7XvfOz0ec2AW0TWwk6ynoz__9-qoJTX6cJRGe6vE3zhlJvz50TzeHYv43pV8OHz3JsnUEVZtQz8lJVSEQd3zH9i},
	doi = {10.1097/QAI.0000000000002598},
	abstract = {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.},
	language = {en-US},
	number = {5},
	urldate = {2021-08-13},
	journal = {JAIDS Journal of Acquired Immune Deficiency Syndromes},
	author = {Crane, Heidi M. and Nance, Robin M. and Avoundjian, Tigran and Harding, Barbara N. and Whitney, Bridget M. and Chow, Felicia C. and Becker, Kyra J. and Marra, Christina M. and Zunt, Joseph R. and Ho, Emily L. and Kalani, Rizwan and Huffer, Andrew and Burkholder, Greer A. and Willig, Amanda L. and Moore, Richard D. and Mathews, William C. and Eron, Joseph J. and Napravnik, Sonia and Lober, William B. and Barnes, Greg S. and McReynolds, Justin and Feinstein, Matthew J. and Heckbert, Susan R. and Saag, Michael S. and Kitahata, Mari M. and Delaney, Joseph A. C. and Tirschwell, David L.},
	month = apr,
	year = {2021},
	pages = {568--578},
}
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