Association of HIV and opportunistic infections with incident stroke

A nationwide population-based cohort study in Taiwan

Yung Feng Yen, Marcelo Chen, Ian Jen, Yu Ching Lan, Pei Hung Chuang, Yen Ling Liu, Yun Lee, Yi Ming Arthur Chen

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. Methods: We identified adults with HIV infection in 2000-2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A timedependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV. Results: Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95% CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95% CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95% CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95% CI: 1.37 to 5.67), and Penicillium marneffei infection (AHR 2.90; 95% CI: 1.16 to 7.28). Conclusions: Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.

Original languageEnglish
Pages (from-to)117-125
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume74
Issue number2
DOIs
Publication statusPublished - Feb 1 2017
Externally publishedYes

Fingerprint

Opportunistic Infections
Taiwan
HIV Infections
Cohort Studies
Stroke
Population
HIV
Confidence Intervals
Cryptococcal Meningitis
Cytomegalovirus
Penicillium
National Health Programs
Infection
Proportional Hazards Models
Blood Vessels
Longitudinal Studies
Atherosclerosis

Keywords

  • HIV
  • Opportunistic infection
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association of HIV and opportunistic infections with incident stroke : A nationwide population-based cohort study in Taiwan. / Yen, Yung Feng; Chen, Marcelo; Jen, Ian; Lan, Yu Ching; Chuang, Pei Hung; Liu, Yen Ling; Lee, Yun; Arthur Chen, Yi Ming.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 74, No. 2, 01.02.2017, p. 117-125.

Research output: Contribution to journalArticle

Yen, Yung Feng ; Chen, Marcelo ; Jen, Ian ; Lan, Yu Ching ; Chuang, Pei Hung ; Liu, Yen Ling ; Lee, Yun ; Arthur Chen, Yi Ming. / Association of HIV and opportunistic infections with incident stroke : A nationwide population-based cohort study in Taiwan. In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 74, No. 2. pp. 117-125.
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abstract = "Background: HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. Methods: We identified adults with HIV infection in 2000-2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A timedependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV. Results: Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87{\%}) during a mean follow-up period of 5.44 years, including 672 (0.63{\%}) ischemic strokes and 255 (0.24{\%}) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95{\%} confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95{\%} CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95{\%} CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95{\%} CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95{\%} CI: 1.37 to 5.67), and Penicillium marneffei infection (AHR 2.90; 95{\%} CI: 1.16 to 7.28). Conclusions: Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.",
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AU - Chen, Marcelo

AU - Jen, Ian

AU - Lan, Yu Ching

AU - Chuang, Pei Hung

AU - Liu, Yen Ling

AU - Lee, Yun

AU - Arthur Chen, Yi Ming

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N2 - Background: HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. Methods: We identified adults with HIV infection in 2000-2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A timedependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV. Results: Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95% CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95% CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95% CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95% CI: 1.37 to 5.67), and Penicillium marneffei infection (AHR 2.90; 95% CI: 1.16 to 7.28). Conclusions: Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.

AB - Background: HIV-associated vasculopathy and opportunistic infections (OIs) might cause vascular atherosclerosis and aneurysmal arteriopathy, which could increase the risk of incident stroke. However, few longitudinal studies have investigated the link between HIV and incident stroke. This cohort study evaluated the association of HIV and OIs with incident stroke. Methods: We identified adults with HIV infection in 2000-2012, using the Taiwan National Health Insurance Research Database. A control cohort without HIV infection, matched for age and sex, was selected for comparison. Stroke incidence until December 31, 2012 was then ascertained for all patients. A timedependent Cox regression model was used to determine the association between OIs and incident stroke among patients with HIV. Results: Among a total of 106,875 patients (21,375 patients with HIV and 85,500 matched controls), stroke occurred in 927 patients (0.87%) during a mean follow-up period of 5.44 years, including 672 (0.63%) ischemic strokes and 255 (0.24%) hemorrhagic strokes. After adjusting for other covariates, HIV infection was an independent risk factor for incident all-cause stroke [adjusted hazard ratio (AHR) 1.83; 95% confidence interval (CI): 1.58 to 2.13]. When the type of stroke was considered, HIV infection increased the risks of ischemic (AHR 1.33; 95% CI: 1.09 to 1.63) and hemorrhagic stroke (AHR 2.01; 95% CI: 1.51 to 2.69). The risk of incident stroke was significantly higher in patients with HIV with cryptococcal meningitis (AHR 4.40; 95% CI: 1.38 to 14.02), cytomegalovirus disease (AHR 2.79; 95% CI: 1.37 to 5.67), and Penicillium marneffei infection (AHR 2.90; 95% CI: 1.16 to 7.28). Conclusions: Patients with HIV had an increased risk of stroke, particularly those with cryptococcal meningitis, cytomegalovirus, or P. marneffei infection.

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KW - Opportunistic infection

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