Study on Gender Differences and Stroke Risk Among HIV-Infected Individuals

Background

Individuals with HIV infection may face a higher risk of stroke, particularly women. However, understanding of whether the influence of various factors on cerebrovascular risk in this population differs by gender and whether these differences contribute to variations in stroke risk remains limited. The main objective of this study is to explore whether gender modifies the impact of demographic characteristics, cardiovascular metabolic factors, health-related behaviors, and HIV-specific variables on stroke risk.

Source

This paper was authored by Dr. Felicia C. Chow, Dr. Robin M. Nance, Dr. Kyra Becker, among others. The study was conducted by multiple research institutions, including the University of California, San Francisco, University of Washington, Seattle, Swedish Medical Center, Seattle, among others. This paper was published in the journal Neurology on August 27, 2024, Volume 103, Issue 4.

Research Process

This study is an observational cohort study that analyzed data from HIV-infected individuals who were followed up between 2005 and 2020 at five CNICS (Centers for AIDS Research Network of Integrated Clinical Systems) sites in the United States. These sites include Johns Hopkins University, University of Alabama at Birmingham, University of California, San Diego, University of North Carolina at Chapel Hill, and University of Washington.

Study Design and Data Sources

Participants were required to have at least two visits within 12 months. The cohort has been followed since 2005, with each site’s earliest follow-up time point, the first patient-reported clinical data, or six months after the first CNICS visit being considered the start time of the observation period.

Testing Time and Data Variables

The observation period’s end points include the occurrence of a stroke event, nine months after the last CNICS visit, patient death, or the end of the study management period. Data collected covered demographic characteristics, cardiovascular metabolic comorbidities, health-related behaviors, and HIV-specific parameters such as CD4 cell count, HIV viral load, and antiretroviral therapy (ART) use.

Data Processing and Results Analysis

All potential stroke events were identified and classified by neurological experts, including types such as ischemic stroke and hemorrhagic stroke. Cox proportional hazards models were used to determine whether gender modifies the relationship between the variables of interest and stroke occurrence, adjusting for participant age and stroke risk scores. Multiple imputation was used to handle missing data.

Main Findings

Stroke Events

Among 13,573 participants, 19% were female, with an average age of 44 years and an average follow-up time of 5.6 years. During the observation period, a total of 162 stroke events were recorded, 83% of which were ischemic strokes.

Interaction Between Age and Gender

The study found that female HIV-infected individuals under 50 years of age had a significantly higher stroke risk compared to males (HR 2.01, 95% CI 1.25-3.21; p = 0.001). Among women aged 40 and under, the stroke risk was double that of men (HR 2.01, 95% CI 1.25–3.21, p = 0.004), while among women aged 50 and over, the gender difference in stroke risk was not significant.

HIV-Specific Factors and Medication Use

Uncontrolled HIV viral load had a greater impact on stroke risk in women (HR 4.66, 95% CI 2.48–8.74) compared to men, where the relationship was not significant (HR 1.30, 95% CI 0.83–2.03; p = 0.001). Similarly, methamphetamine use had a more substantial negative impact on women (HR 4.78, 95% CI 1.47–15.56), with no significant effect observed in men.

Cardiovascular Disease and Other Comorbidities

In women, hypertension treatment had a more significant impact on stroke risk (HR 3.44, 95% CI 1.74–6.81) compared to men, where the effect was smaller (HR 1.66, 95% CI 1.14–2.41; p = 0.06). Women with a history of diabetes, higher BMI, and higher ASCVD scores were at higher risk for stroke.

Conclusion

This study concludes that younger female HIV-infected individuals face a higher cerebrovascular risk compared to their male counterparts. Additionally, uncontrolled HIV viral load, methamphetamine use, and hypertension treatment have more pronounced negative effects in women, underscoring the need for individualized and gender-specific strategies in predicting and preventing cerebrovascular risks among HIV-infected individuals.

Research Value and Applications

This study provides critical insights into the role of gender in stroke risk among HIV-infected individuals, indicating the importance of considering gender differences when developing stroke prevention strategies. These findings contribute to the development of more personalized prevention measures for adverse health events among HIV-infected individuals, particularly for young women at higher stroke risk.

Research Highlights

• The study employed advanced Cox proportional hazards models and multiple imputation methods to ensure data analysis accuracy.
• The research not only provides an overall view of stroke incidence but also delves into the gender and age differences in stroke risk.
• The results highlight the importance of considering gender and specific HIV-related factors when developing stroke prevention strategies.

Additional Valuable Information

The paper emphasizes the need for increased attention to the specific needs of women in HIV management and calls for further research to elucidate the specific mechanisms by which gender influences cerebrovascular risk. These findings may lead to the development of gender-specific guidelines for stroke risk in HIV-infected individuals, improving patient clinical outcomes.

Conclusion

This study reveals significant gender differences in stroke risk among HIV-infected individuals. These findings provide new directions for future clinical practice, suggesting that personalized stroke prevention measures should be implemented for female HIV-infected individuals to reduce stroke incidence.