• J Stroke Cerebrovasc Dis · Oct 2013

    Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study.

    • Madeleine Durand, Odile Sheehy, Jean-Guy Baril, Jacques LeLorier, and Cécile L Tremblay.
    • Internal Medicine Service, Centre Hospitalier de l'Univsersité de Montréal (CHUM), Montréal, Québec, Canada. Electronic address: madeleine.durand.chum@ssss.gouv.qc.ca.
    • J Stroke Cerebrovasc Dis. 2013 Oct 1; 22 (7): e34-41.

    BackgroundWe studied the association between HIV infection, antiretroviral medications, and the risk of spontaneous intracranial hemorrhage.MethodsWe performed a cohort and nested case control study in an administrative database. We selected all HIV-positive individuals presenting between 1985 and 2007. Each HIV-positive subject was matched with 4 HIV-negative individuals. We used a Poisson regression model to calculate rates of intracranial hemorrhage according to HIV status. We conducted a case -control study nested within the cohort of HIV-positive individuals to look at the effect of antiretroviral medications. Odds ratios for antiretroviral exposure were obtained using conditional logistic regression.ResultsThere were 7,053 HIV-positive and 27,681 HIV-negative subjects, representing 138,704 person-years. There were 49 incident intracranial hemorrhages, 29 in HIV-positive and 20 in HIV-negative individuals. The adjusted hazard ratio for intracranial hemorrhage in HIV-positive compared to HIV-negative patients was 3.28 (95% confidence interval [CI] 1.75-6.12). The effect was reduced to 1.99 (95% CI 0.92-4.31) in the absence of AIDS-defining conditions, and increased to 7.64 (95% CI 3.78-15.43) in subjects with AIDS-defining conditions. Hepatitis C infection, illicit drug or alcohol abuse, intracranial lesions, and coagulopathy were all strongly associated with intracranial hemorrhage (all P < .001). In the case control study, 29 cases of ICH in HIV-positive individuals were matched to 228 HIV-positive controls. None of the antiretroviral classes were associated with an increase in the odds ratio of intracranial hemorrhage.ConclusionsThe risk of intracranial hemorrhage in HIV-positive individuals seems to be mostly associated with AIDS-defining conditions, other comorbidities, or lifestyle factors. No association was found between use of antiretroviral medications and intracranial hemorrhage.Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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