D'Ascenzo Fabrizio, Quadri Giorgio, Cerrato Enrico, Calcagno Andrea, Omedè Pierluigi, Grosso Marra Walter, Abbate Antonio, Bonora Stefano, Biondi Zoccai Giuseppe, Moretti Claudio, Gaita Fiorenzo
aDivision of Cardiology, University of Turin, Turin bDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy cVCU Pauley Heart Center, Richmond, Virginia, USA dUnit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin eMeta-analysis and Evidence Based Medicine Training in Cardiology (METCARDIO), Ospedaletti, Italy.
J Cardiovasc Med (Hagerstown). 2015 Dec;16(12):839-43. doi: 10.2459/JCM.0b013e328365ca31.
Recent studies have suggested a close biological and clinical association between HIV infection and risk of myocardial infarction, whereas contrasting data have been reported about incidence of stroke and its clinical predictors.
Studies including HIV-infected patients developing a cerebral ischemic event were systematically searched for in MEDLINE/PubMed.
Baseline, treatment and outcome data were appraised and pooled with random-effects methods computing summary estimates (95% confidence intervals).
Five studies comprising 89,713 participants were included: they were young [46 (46-50) years, mainly male (70% (68-79)] with a moderate prevalence of diabetes [19% (14-21)]. Atrial fibrillation and history of previous coronary artery disease were observed in 3% (2-5) and 18% (15-22), respectively. All patients were on highly active antiretroviral therapy (HAART) and had been treated for a mean of 5 (2-6) years. After a median of 4 (3-5) years of follow-up, 1245 ischemic strokes occurred [1.78% (0.75-2.81)]. Traditional risk factors such as age (five studies), hypertension (three studies), smoking (two studies), hyperlipidemia (one study), atrial fibrillation (one study) and diabetes (one study) were identified as independent predictors of stroke. In one study, RNA viral load [log of odds ratio = 1.10 (1.04-1.17)] and CD4+ cell count less than 200/μl were clinically related to stroke, whereas HAART therapy showed a neutral effect.
Stroke represents a relatively common complication in young, HAART-treated HIV patients. Apart from traditional cardiovascular risk factors, HIV-RNA viral load may help to target and manage patients at risk.
近期研究表明，HIV感染与心肌梗死风险之间存在密切的生物学和临床关联，而关于中风发病率及其临床预测因素的报道则相互矛盾。
在MEDLINE/PubMed中系统检索了包括发生脑缺血事件的HIV感染患者的研究。
对基线、治疗及结局数据进行评估，并采用随机效应方法进行汇总，计算汇总估计值（95%置信区间）。
纳入了5项研究，共89713名参与者：他们较为年轻[46（46 - 50）岁，主要为男性（70%（68 - 79）]，糖尿病患病率中等[19%（14 - 21）]。分别有3%（2 - 5）和18%（15 - 22）的患者存在心房颤动和既往冠状动脉疾病史。所有患者均接受高效抗逆转录病毒治疗（HAART），平均治疗时间为5（2 - 6）年。经过中位时间4（3 - 5）年的随访，发生了1245例缺血性中风[1.78%（0.75 - 2.81）]。年龄（5项研究）、高血压（3项研究）、吸烟（2项研究）、高脂血症（1项研究）、心房颤动（1项研究）和糖尿病（1项研究）等传统危险因素被确定为中风的独立预测因素。在1项研究中，RNA病毒载量[比值比的对数 = 1.10（1.04 - 1.17）]和CD4 +细胞计数低于200/μl与中风在临床上相关，而HAART治疗显示出中性作用。
中风是年轻的接受HAART治疗的HIV患者中相对常见的并发症。除传统心血管危险因素外，HIV - RNA病毒载量可能有助于确定和管理高危患者。
