2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Clinical and demographic characteristics by stroke status

Characteristic

Ischemic stroke not due to drugs/infection %

Ischemic stroke due to drugs or infection %

No ischemic stroke %

Male

76 22 36 28

73 44 39 15 19 68 10 26 42 27 48 26 26 35 3

79 50 32 14 42 43 10 48 19 28 25 21 54 18 3

Sex

<40

40-49 50-59

Age (years)

≥60

15

White Black

36 59

Race/ethnicity

Hispanic

4

MSM

30 27 37 38 20 43 26

IDU

Risk Factor

Heterosexual

0-200

CD4 Count (cells/mm 3 )

201-350

>350

Co-infected

HCV

Slide31of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Risk factors for ischemic strokes

Covariate

aHR 95%CI

P-Value

▪ Ischemic strokes associated with traditional risk factors such as age, diabetes, HTN ▪ Ischemic strokes associated with HIV-specific risk factors such as CD4 count, HCV

Age (per year)

1.06

1.04-1.08 <0.01

Female

Ref

Male

0.96

0.67-1.38

0.8

WhiteRace/Ethnicity

Ref

Black

1.78

1.24-2.55 <0.01

Hispanic

0.96

0.48-1.91

0.9

Other

0.78

0.24-2.5

0.6

Viral load: time updated (>400)

1.29

0.91-1.84

0.1

CD4+ count: time updated (per 100 cells/mm 3 )

0.86

0.80-0.91 <0.01

HCV

1.42

1.00-2.01 <0.01

Diabetes

1.69

1.04-2.74

0.03

Treated hypertension

2.26

1.53-3.35 <0.01

Treated dyslipidemia (statin use)

1.83

1.05-3.19

0.03

Smoker

1.1

0.75-1.53

0.4

In analyses restricted to ischemic strokes not secondary to infection or illicit-drug use • HCVwas no longer significantly associated with stroke • The impact of CD4 count was smaller • Diabetes and HTN associations with risk of ischemic stroke were larger

Slide32of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

VTEs in HIV

BothLower andUpper

extremity,1% Other,22%

▪ DVT most common ▪ Mean age 49 ▪ Predisposing

Upperextremity,4%

Lower extremity, 73%

Combo 12%

conditions ▫ Infections 27% ▫ Hospitalizations 21% ▫ Malignancy 17% ▫ IDU 13% ▫ Immobilization 12%

CAT 9%

DVT 50%

PE 29%

Slide33of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.