Association of cytomegalovirus end-organ disease with stroke in people living with HIV/AIDS: A nationwide population-based cohort study

Yung Feng Yen, Ian Jen, Marcelo Chen, Pei Hung Chuang, Yen Ling Liu, Gerald B. Sharp, Yi Ming Arthur Chen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Cytomegalovirus (CMV) infection might increase the risk of cardiovascular event. However, data on the link between incident stroke and co-infections of CMV and human immunodeficiency virus (HIV) are limited and inconsistent. This nationwide population-based cohort study analyzed the association of CMV end-organ disease and stroke among people living with HIV/AIDS (PLWHA). Methods: From January 1, 1998, this study identified adult HIV individuals with and without CMV endorgan disease in the Taiwan National Health Insurance Research Database. All patients were observed for incident stroke and were followed until December 31, 2012. Time-dependent analysis was used to evaluate associations of CMV end-organ disease with stroke. Results: Of the 22,581 PLWHA identified (439 with CMV end-organ disease and 22,142 without CMV end-organ disease), 228 (1.01%) had all-cause stroke during a mean follow-up period of 4.85 years, including 169 (0.75%) with ischemic stroke and 59 (0.26%) with hemorrhagic stroke. After adjusting for age, sex, comorbidities, opportunistic infections after HIV diagnosis, and antiretroviral treatment, CMV end-organ disease was found to be an independent risk factor for incident all-cause stroke (adjusted hazard ratio [AHR], 3.07; 95% confidence interval [CI], 1.70 to 5.55). When stroke type was considered, CMV end-organ disease was significantly positively associated with the risk of ischemic stroke (AHR, 3.14; 95% CI, 1.49 to 6.62) but not hemorrhagic stroke (AHR, 2.52; 95% CI, 0.64 to 9.91). Conclusions: This study suggested that CMV end-organ disease was an independent predictor of ischemic stroke among PLWHA.

Original languageEnglish
Article numbere0151684
JournalPLoS One
Volume11
Issue number3
DOIs
Publication statusPublished - Mar 1 2016
Externally publishedYes

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Cytomegalovirus
Human immunodeficiency virus
cohort studies
stroke
Viruses
Acquired Immunodeficiency Syndrome
Cohort Studies
Stroke
HIV
Population
Hazards
confidence interval
Confidence Intervals
Health insurance
health insurance
Opportunistic Infections
Cytomegalovirus Infections
National Health Programs
mixed infection
Coinfection

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Association of cytomegalovirus end-organ disease with stroke in people living with HIV/AIDS : A nationwide population-based cohort study. / Yen, Yung Feng; Jen, Ian; Chen, Marcelo; Chuang, Pei Hung; Liu, Yen Ling; Sharp, Gerald B.; Chen, Yi Ming Arthur.

In: PLoS One, Vol. 11, No. 3, e0151684, 01.03.2016.

Research output: Contribution to journalArticle

Yen, Yung Feng ; Jen, Ian ; Chen, Marcelo ; Chuang, Pei Hung ; Liu, Yen Ling ; Sharp, Gerald B. ; Chen, Yi Ming Arthur. / Association of cytomegalovirus end-organ disease with stroke in people living with HIV/AIDS : A nationwide population-based cohort study. In: PLoS One. 2016 ; Vol. 11, No. 3.
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abstract = "Objectives: Cytomegalovirus (CMV) infection might increase the risk of cardiovascular event. However, data on the link between incident stroke and co-infections of CMV and human immunodeficiency virus (HIV) are limited and inconsistent. This nationwide population-based cohort study analyzed the association of CMV end-organ disease and stroke among people living with HIV/AIDS (PLWHA). Methods: From January 1, 1998, this study identified adult HIV individuals with and without CMV endorgan disease in the Taiwan National Health Insurance Research Database. All patients were observed for incident stroke and were followed until December 31, 2012. Time-dependent analysis was used to evaluate associations of CMV end-organ disease with stroke. Results: Of the 22,581 PLWHA identified (439 with CMV end-organ disease and 22,142 without CMV end-organ disease), 228 (1.01{\%}) had all-cause stroke during a mean follow-up period of 4.85 years, including 169 (0.75{\%}) with ischemic stroke and 59 (0.26{\%}) with hemorrhagic stroke. After adjusting for age, sex, comorbidities, opportunistic infections after HIV diagnosis, and antiretroviral treatment, CMV end-organ disease was found to be an independent risk factor for incident all-cause stroke (adjusted hazard ratio [AHR], 3.07; 95{\%} confidence interval [CI], 1.70 to 5.55). When stroke type was considered, CMV end-organ disease was significantly positively associated with the risk of ischemic stroke (AHR, 3.14; 95{\%} CI, 1.49 to 6.62) but not hemorrhagic stroke (AHR, 2.52; 95{\%} CI, 0.64 to 9.91). Conclusions: This study suggested that CMV end-organ disease was an independent predictor of ischemic stroke among PLWHA.",
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