Incidence and clinical features of stroke in HIV patients in HAART era: a meta-analysis

Purpose: Recent studies have suggested a close biological and clinical association between HIV infection and risk of myocardial infarction, while contrasting data have been reported about incidence and predictors of stroke in these patients. Methods: Studies including patients with HIV developing a cerebral ischemic event were systematically searched for in MEDLINE/PubMed. Baseline, treatment and outcome data were appraised and pooled with random effect methods computing summary estimates (95% confidence intervals). Results: Five studies with a total of 87130 subjects were included. Patients were young (47 years [95% CI: 46-50]), mainly male (71%: 68-79) with low rates of diabetes (18.5%: 13.8-21) and dyslipidemia (22%: 16-29): habit of smoking (46%: 38.5-50) and diagnosis of hypertension (47.5%: 38-56) were reported more frequently. Atrial fibrillation and history of previous coronary artery disease were observed in 3% (2-5.4) and 18% (15-22: all CI 95%). All patients were on Highly Active Anti-Retroviral Therapy (HAART) with at least 2 drugs for a mean of 4.5 [2-6] years. Median CD4+ cells count was 473/mm3 (437-500) with a nadir of 230/mm3 (210-250). At a median of 4 years (3-4.5) 1245 ischemic strokes occurred (1.78%: 0.75, 2.81).Traditional risk factors like age (4 studies), hypertension (2 studies), smoking (2 studies), atrial fibrillation and diabetes (1 study) were identified as independent predictors of stroke. In one study, RNA viral load (OR 1.10; 1.04-1.17) was clinically related to stroke, while HAART therapy showed a neutral effect. Conclusions: Stroke represents a relatively common complication in young, HAART-treated HIV patients. Apart from traditional cardiovascular risk factors, HIV-RNA viral load may help to target and manage population at risk.