Clinical characteristics of HIV patients with acute stroke (P5.102)

Objective: To explore the epidemiology, vascular distribution and role of traditional risk factors in stroke affecting HIV-positive patients Background: Stroke constitutes a major contributor to morbidity and mortality in patients with HIV. Vasculopathy related to HIV is thought to play a major role in the pathogenesis of stroke. Factors such as virus-induced inflammation, opportunistic infections and antiretroviral (ARV) agents with pro-atherosclerotic effects have all been linked to this process. Design/Methods: We performed a retrospective analysis of 34 patients diagnosed with HIV and stroke at our hospital between 2009 and 2017. We obtained epidemiological data regarding their stroke and HIV diagnoses. Results: The median age at the time of stroke onset was 52 years (range 24–78) with 78% male. All patients were on ARVs and 75% were virologically suppressed at the time of stroke. Eighty-six percent of strokes were ischemic stroke. The anterior circulation was the most common vascular territory affected with 47%, followed by concurrent anterior-posterior (28%) and posterior alone (25%). Imaging evidence of intracranial atherosclerosis was detected in 60% of patients who underwent vascular studies. There was a non-significant decrease in median CD4 count at the time of the stroke (p=0.092) followed by a significant increase in median CD4 count at 90–270 days following (p=0.049). Diabetes was present in 20% and 50% had hypertension. The median LDL was 97mg/dL (range 18–198) and 41% were smokers. Conclusions: Our study illustrates the burden of stroke in an HIV cohort despite good rates of virologic suppression and only modest presence of traditional risk factors. This, coupled with the finding of disproportionate intracranial atherosclerosis, suggests a possible role of HIV vasculopathy. Additionally, the decline in CD4 count at the time of stroke could suggest an increased risk of stroke in patients with lower CD4 count. We suggest additional controlled studies to explore this further. Disclosure: Dr. Gonzalez has nothing to disclose. Dr. Warrior has nothing to disclose. Dr. Sierra Morales has nothing to disclose. Dr. Rice has nothing to disclose. Dr. Diep has nothing to disclose. Dr. Kelly has nothing to disclose.