Stroke and HIV-Associated Neurological Complications: A Retrospective Nationwide Study.

INTRODUCTION There is increased risk of stroke and other neurological complications in HIV with no large population-based studies in the literature. We aim to evaluate the prevalence of stroke, HIV-associated neurological complications and identify risk factors associated with poor outcome of stroke among HIV admissions in the US. METHODS In the Nationwide Inpatient Sample with adult HIV hospitalizations, patients with primary cerebrovascular disease (CeVDs) and HIV-associated neurological complications were identified by ICD-9-CM codes. We performed a retrospective study with weighted analysis to evaluate prevalence of stroke and neurological complications, and outcomes of stroke among HIV patients. RESULTS We included 1,559,351 HIV admissions from 2003-2014, of which 22470 (1.4%) patients had CeVDs [TIA:3240 (0.2%), AIS:14895 (0.93%) and HS:4334 (0.27%)], 7781 (0.49%) had neurosyphilis, 29925 (1.87%) meningitis, 39190 (2.45%) cytomegalovirus encephalitis, 4699 (0.29%) toxoplasmosis, 9964 (0.62%) progressive multifocal leukoencephalopathy (PML), and 142910 (8.94%) epilepsy. The is increased overall prevalence trend for CeVDs (TIA:0.17% to 0.24%; AIS:0.62% to 1.29%; HS:0.26% to 0.31%; pTrend<0.0001) from 2003 to 2014. Among HIV admissions, variables associated with AIS were neurosyphilis (OR:4.38; 95%CI:3.21-5.97), meningitis [4.87(4.10-5.79)], CNS tuberculosis [6.72(3.85-11.71)]. Toxoplasmosis [4.27(2.34-7.76)], meningitis [2.91(2.09-4.06)], and cytomegalovirus encephalitis [1.62(1.11-2.37)] were associated with higher odds of HS compared to patients without HS. CONCLUSION There was an increasing trend of CeVDs over time among HIV hospitalizations. HIV-associated neurological complications were associated with risk of stroke and together increased mortality, morbidity, disability and discharge to long-term care facilities. Further research would clarify stroke risk factors in HIV patients to mitigate adverse outcomes. This article is protected by copyright. All rights reserved.