Abstract Details

Title Incidence Rates of Intracerebral Hemorrhage Are Increased in Young and Female HIV-Infected Individuals

Topic Infections/AIDS/Prion Disease

Presentation(s) S38 - (-)

Poster/Presentation
Number 004

Objective

Background Cardiovascular and cerebrovascular event rates are increased in HIV infection. The association specifically between HIV and ICH, which has a mechanism distinct from ischemic stroke, is less clear.

Design/Methods We observed a cohort of 4,255 HIV-infected and 35,305 demographics-matched HIV-uninfected individuals from a large Boston-based health care system between 1996 and 2009. The primary outcome was first-time ICH, defined by ICD-9-CM code 431. ICH incidence rates were determined in age and gender-stratified analyses. We applied Cox proportional hazard modeling to evaluate the association between HIV and ICH within age strata. An HIV-specific model assessed ICH risk factors among HIV-infected individuals.

Results The incidence rate of ICH in HIV-infected individuals was 2.44 per 1000 person-years compared with 1.29 in the uninfected cohort, with an incidence rate ratio (IRR) of 1.89 (95% confidence interval 1.41-2.49, p<0.0001). In all age strata less than 56 years, HIV-infected individuals had a higher rate of ICH compared with controls. In gender-stratified analyses, rates of ICH were increased in both HIV-infected men and women, although the increase was relatively more pronounced in women (IRR 3.05, 1.72-5.18, p=0.0001 for women; IRR 1.55, 1.09-2.16, p=0.01 for men). In a multivariate model, HIV predicted higher comparative rates of ICH among individuals 55 and younger (hazard ratio [HR] 1.98, 1.46-2.69, p<0.001). In the HIV-specific model, recent CD4 count less than 200 was associated with a four-fold increase in the rate of ICH (HR 3.99, 1.74-9.16, p=0.001).

Conclusions The increased incidence rate of ICH in HIV-infected individuals was driven by younger age groups and women and persisted in younger individuals after adjustment for ICH risk factors. Additional studies are warranted to investigate the effect of HIV-specific factors on ICH risk.

Authors/Disclosures
Felicia Chow, MD (Zuckerberg San Francisco General Hospital) PRESENTER	Dr. Chow has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Medicolegal consulting. The institution of Dr. Chow has received research support from NIH.
	No disclosure on file
Wei He, MD (Katy Neurology, PLLC)	No disclosure on file
Steven K. Feske, MD (Boston Medical Center, Neurology Department)	Dr. Feske has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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