Stroke Outcomes Among HIV-infected Patients in a Large, Urban, Tertiary Hospital in the USA, 1999–2016

BACKGROUND: HIV infection is an independent risk factor for stroke. However, patient-level data on stroke outcomes among HIV-infected patients are limited. We compared stroke outcomes between HIV-infected and -uninfected patients in a large tertiary hospital. METHODS: We used data from the Stroke Management and Rehabilitation Team, a patient-level database of all stroke admissions among adult patients at Barnes-Jewish Hospital, St. Louis, Missouri. All patients hospitalized with a first stroke episode from 1999 to 2016 were included. Variables between groups were compared using independent samples t-test or the Wilcoxon rank-sum test for continuous variables and the chi-square or Fisher’s exact test for categorical variables when applicable. Spearman’s test was used for correlation analyses. RESULTS: Of 20,268 patients, 81 were HIV-infected. The median CD4+ count was 148 cells/µL and 38% had HIV viral load < 200 copies/mL at stroke presentation. Compared with HIV-uninfected patients, HIV-infected patients were significantly younger (49 vs. 65 years, P = 0.010) and had higher rates of smoking, alcohol and illicit drug use (table). Comorbid conditions, stroke severity, length of hospital stay, and rates of inpatient mortality and hospital complications between the two groups were similar. The proportion of stroke admissions among HIV-infected patients peaked in 2010–2011 (figure). From 1999 to 2016, the age of HIV-infected patients at presentation increased (r = 0.40, P < 0.010) while it remained stable for HIV-uninfected patients. Conversely, the HIV viral load at presentation declined over time (r = −0.53, P < 0.001) while there was no correlation between CD4+ count and year of admission. The proportion of comorbid conditions among HIV-infected patients was also not statistically different before and after 2010–2011. CONCLUSION: In this large cohort, we found that HIV-infected patients had comparable stroke outcomes and comorbid conditions as HIV-uninfected patients who, on average, were 16 years older. Our finding that HIV-infected patients present with stroke at older ages and with lower viral load over time suggests a potential change in the pathogenesis of stroke from viral-driven processes to more aging-related risk factors. DISCLOSURES: B. Ances, Journal of Neurovirology: Editorial Board but not compensation, Nothing.