Published Online
on December 18, 2003

A more recent version of this article appeared on January 1, 2004

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Submitted on August 4, 2003
Accepted on September 2, 2003

Acquired Immunodeficiency Syndrome and the Risk of Stroke

John W. Cole MD^*; Amelia N. Pinto MD; J. Richard Hebel PhD; David W. Buchholz MD; Christopher J. Earley MD, PhD; Constance J. Johnson MD; Richard F. Macko MD; Thomas R. Price MD; Michael A. Sloan MD; Barney J. Stern MD; Robert J. Wityk MD; Marcella A. Wozniak MD, PhD; and Steven J. Kittner MD, MPH

From the Departments of Neurology (J.W.C., S.J.K, R.F.M., M.A.W.) and Epidemiology and Preventive Medicine (J.W.C., S.J.K., J.R.H., T.R.P), University of Maryland, Baltimore; Geriatrics Research, Education, and Clinical Center (S.J.K., R.F.M.), Baltimore Department of Veterans Affairs Medical Center, Baltimore, Md; Department of Neurology (A.N.P.), Hospital Fernando Fonseca, Amadora, Portugal; Department of Neurology (D.W.B., C.J.E., R.J.W.), Johns Hopkins University, Baltimore, Md; Neurological Medicine (C.J.J.), Clarksville, Tenn; Department of Neurology (M.A.S.), Rush University, Chicago, Ill; and Department of Neurology (B.J.S.), Emory University, Atlanta, Ga.

^* To whom correspondence should be addressed. E-mail: jwc007{at}dnamail.com.

Background and Purpose--Although acquired immunodeficiency syndrome (AIDS) is thought to increase the risk of stroke, few data exist to quantify this risk. This is the first population-based study to quantify the AIDS-associated risk of stroke.

Methods--We identified all incident ischemic stroke (IS) and intracerebral hemorrhage (ICH) cases among young adults 15 to 44 years of age in central Maryland and Washington, DC, who were discharged from any of the 46 hospitals in the study area in 1988 and 1991. Using data from the medical records, 2 neurologists reviewed each case to confirm the diagnosis. Cases of AIDS among these patients with stroke were defined using Centers for Disease Control and Prevention criteria (1987). The number of cases of AIDS in the central Maryland and Washington population during 1988 and 1991 was determined from regional health departments working with the Centers for Disease Control and Prevention. Poisson regression was used to estimate the age-, race-, and sex-adjusted relative risk of stroke associated with AIDS.

Results--There were 385 IS cases (6 with AIDS) and 171 ICH cases (6 with AIDS). The incidences of IS and ICH among persons with AIDS were both 0.2% per year. AIDS conferred an adjusted relative risk of 13.7 (95% confidence interval [CI], 6.1 to 30.8) for IS and 25.5 (95% CI, 11.2 to 58.0) for ICH. After exclusion of 5 cases of stroke in AIDS patients in whom other potential causes were identified, AIDS patients continued to have an increased risk of stroke with an adjusted relative risk of 9.1 (95% CI, 3.4 to 24.6) for IS and 12.7 (95% CI, 4.0 to 40.0) for ICH.

Conclusions--This population-based study found that AIDS is strongly associated with both IS and ICH.

Key words: acquired immunodeficiency syndrome • epidemiology • HIV • stroke

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