Cerebrovascular Disease and HIV in Singapore: A Single-Centre Study (P1.325)

Objective: To describe epidemiology, clinical features and outcomes of human immunodeficiency virus (HIV) patients with acute cerebrovascular disease (CVD). Background: HIV infection is a risk factor for stroke, with several postulated etiological mechanisms. In Asia, there is paucity of data describing CVD in HIV patients. Methods: CVD (ischemic or hemorrhagic stroke, venous thrombosis) patients presenting to Tan Tock Seng Hospital between Apr 2004 and Dec 2014 were cross-matched with the hospital’s HIV database to identify those who developed CVD at or after diagnosis of HIV. Demographic, clinical, laboratory and neuroradiological information was obtained through retrospective chart review. Results: Of 26,998 CVD patients, 38 (mean age 52.7 ± 12.6 years; 36 male) had HIV infection. Sixteen (42.1[percnt]) presented within 2 years of HIV diagnosis; 2 (5.3[percnt]) diagnosed at index event. Fifteen (39.5[percnt]) were on anti-retroviral treatment. CVD included 34 (89.5[percnt]) ischemic strokes (IS), 4 (10.5[percnt]) hemorrhagic strokes (HS); none had venous thrombosis. Amongst IS patients, 24/34 (70.6[percnt]) had ≥ 2 and 10/34 (29.4[percnt]) had ≤ 1 out of 7 cerebrovascular risk factors. Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification amongst IS patients was: large artery atherosclerosis 9 (26.5[percnt]), cardioembolic 9 (26.5[percnt]), small vessel disease 6 (17.6[percnt]), undetermined etiology 5 (14.7[percnt]). 4/34 IS patients were diagnosed with concurrent infections: 1 each for cryptococcal meningitis, tuberculous vasculitis, cryptococcosis/amoebiasis and cerebral toxoplasmosis. 3/4 had fever at presentation. 2/4 HS patients had thrombocytopenia. Mortality was: overall 7/38 (18.4[percnt]), infection-related IS 1/4 (25[percnt]), HS 3/4 (75[percnt]). 17/38 (44.7[percnt]) patients were discharged with no/mild functional impairment (modified Rankin Scale 0-2). 5/34 (14.7[percnt]) IS patients had recurrent IS within 12 months. Conclusions: Prevalence of CVS risk factors was significant in our population. Stroke in HIV patients may result from other disease mechanisms and carries significant mortality and morbidity. Fever at presentation suggests an infective etiology. Disclosure: Dr. Gan holds stock and/or stock options in a company which sponsored research in which Dr. Gan was involved as an investigator. Dr. Saini has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Ng has nothing to disclose. Dr. Tan has nothing to disclose.