男性中的艾滋病毒感染状况与缺血性中风风险
HIV status and the risk of ischemic stroke among men.
作者信息
Sico Jason J, Chang Chung-Chou H, So-Armah Kaku, Justice Amy C, Hylek Elaine, Skanderson Melissa, McGinnis Kathleen, Kuller Lewis H, Kraemer Kevin L, Rimland David, Bidwell Goetz Matthew, Butt Adeel A, Rodriguez-Barradas Maria C, Gibert Cynthia, Leaf David, Brown Sheldon T, Samet Jeffrey, Kazis Lewis, Bryant Kendall, Freiberg Matthew S
机构信息
From the VA Connecticut Health Care System (J.J.S., A.C.J., M.S., K.M.), West Haven Veterans Administration Medical Center, West Haven; Yale University School of Medicine (J.J.S., K.S.-A., A.C.J.), New Haven, CT; University of Pittsburgh School of Medicine (C.-C.H.C., K.L.K., A.A.B.); University of Pittsburgh Graduate School of Public Health (C.-C.H.C., L.H.K.), Pittsburgh, PA; Boston Medical Center (E.H.), MA; Emory University School of Medicine and Atlanta Veterans Administration Medical Center (D.R.), Atlanta, GA; David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Health Care System (M.B.G., D.L.), Los Angeles, CA; VA Pittsburgh Health Care System (A.A.B.), Pittsburgh, PA; Michael E. DeBakey Veterans Administration Medical Center and Baylor College of Medicine (M.C.R.-B.), Houston, TX; Washington DC Veterans Administration Medical Center and George Washington University School of Medicine (C.G.), Washington, DC; James J. Peters VA (S.T.B.), Bronx; Mount Sinai School of Medicine (S.T.B.), New York, NY; Boston University School of Medicine (J.S.), MA; Center for the Assessment of Pharmaceutical Practices (L.K.), Department of Health Policy and Management, Boston University School of Public Health; Center for Healthcare Organization and Implementation Research (L.K.), a Center for Innovation, Veterans Administration Medical Center, Bedford, MA; National Institute on Alcohol Abuse and Alcoholism (K.B.), Bethesda, MD; and Vanderbilt University School of Medicine and the Nashville Veterans Affairs Medical Center (M.S.F.), Nashville, TN.
出版信息
Neurology. 2015 May 12;84(19):1933-40. doi: 10.1212/WNL.0000000000001560. Epub 2015 Apr 10.
OBJECTIVE
Given conflicting data regarding the association of HIV infection and ischemic stroke risk, we sought to determine whether HIV infection conferred an increased ischemic stroke risk among male veterans.
METHODS
The Veterans Aging Cohort Study-Virtual Cohort consists of HIV-infected and uninfected veterans in care matched (1:2) for age, sex, race/ethnicity, and clinical site. We analyzed data on 76,835 male participants in the Veterans Aging Cohort Study-Virtual Cohort who were free of baseline cardiovascular disease. We assessed demographics, ischemic stroke risk factors, comorbid diseases, substance use, HIV biomarkers, and incidence of ischemic stroke from October 1, 2003, to December 31, 2009.
RESULTS
During a median follow-up period of 5.9 (interquartile range 3.5-6.6) years, there were 910 stroke events (37.4% HIV-infected). Ischemic stroke rates per 1,000 person-years were higher for HIV-infected (2.79, 95% confidence interval 2.51-3.10) than for uninfected veterans (2.24 [2.06-2.43]) (incidence rate ratio 1.25 [1.09-1.43]; p < 0.01). After adjusting for demographics, ischemic stroke risk factors, comorbid diseases, and substance use, the risk of ischemic stroke was higher among male veterans with HIV infection compared with uninfected veterans (hazard ratio 1.17 [1.01-1.36]; p = 0.04).
CONCLUSIONS
HIV infection is associated with an increased ischemic stroke risk among HIV-infected compared with demographically and behaviorally similar uninfected male veterans.
目的
鉴于关于HIV感染与缺血性中风风险之间关联的数据存在冲突，我们试图确定HIV感染是否会增加男性退伍军人患缺血性中风的风险。
方法
退伍军人老龄化队列研究 - 虚拟队列由接受治疗的HIV感染和未感染退伍军人组成，这些退伍军人在年龄、性别、种族/民族和临床地点方面进行了匹配（1:2）。我们分析了退伍军人老龄化队列研究 - 虚拟队列中76835名无基线心血管疾病的男性参与者的数据。我们评估了人口统计学、缺血性中风风险因素、合并疾病、物质使用、HIV生物标志物以及2003年10月1日至2009年12月31日期间缺血性中风的发病率。
结果
在中位随访期5.9（四分位间距3.5 - 6.6）年期间，有910例中风事件（37.4%为HIV感染者）。HIV感染者每1000人年的缺血性中风发生率（2.79，95%置信区间2.51 - 3.10）高于未感染退伍军人（2.24 [2.06 - 2.43]）（发病率比1.25 [1.09 - 1.43]；p < 0.01）。在调整了人口统计学、缺血性中风风险因素、合并疾病和物质使用后，与未感染退伍军人相比，感染HIV的男性退伍军人患缺血性中风的风险更高（风险比1.17 [1.01 - 1.36]；p = 0.04）。
结论
与人口统计学和行为学上相似的未感染男性退伍军人相比，HIV感染与HIV感染者缺血性中风风险增加有关。
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