美国 HIV 感染人群队列中与传统和非传统因素相关的卒中风险的性别差异。
Sex Differences in the Risk of Stroke Associated With Traditional and Non-Traditional Factors in a US Cohort of People With HIV Infection.
机构信息
From the Departments of Neurology (F.C.C.) and Medicine (Infectious Diseases) (F.C.C.), University of California, San Francisco; Departments of Medicine (R.M.N., C.M.M., J.R.Z., M.M.K., H.M.C.), Neurology (K.B., E.L.H., A.H., R.K., C.M.M., J.R.Z., D.L.T.), and Global Health (J.R.Z.), University of Washington, Seattle; Swedish Neuroscience Institute (E.L.H.), Swedish Medical Center, Seattle, Washington; Department of Epidemiology (J.R.Z., J.A.D.), University of Washington, Seattle; Department of Medicine (L.B., E.C.), University of California, San Diego; Department of Medicine (G.A.B., M.S.S., A.L.W.), University of Alabama, Birmingham; Department of Medicine (J.J.E., S.N.), University of North Carolina, Chapel Hill; Department of Medicine (J.K., R.D.M.), Johns Hopkins University; and University of Manitoba (J.A.D.), Winnipeg, Canada.
出版信息
Neurology. 2024 Aug 27;103(4):e209726. doi: 10.1212/WNL.0000000000209726. Epub 2024 Aug 1.
BACKGROUND AND OBJECTIVES
Although stroke risk associated with HIV may be greater for women than men, little is known about whether the impact of different factors on cerebrovascular risk varies by sex in people with HIV (PWH) and contributes to stroke risk disparities in this population. The primary objective of this study was to examine whether sex modifies the effect of demographics, cardiometabolic factors, health-related behaviors, and HIV-specific variables on stroke risk in PWH from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort.
METHODS
In this observational cohort study, we analyzed data from clinical encounters for PWH followed at 5 CNICS sites from approximately 2005 to 2020. All potential stroke events were adjudicated by neurologists. Patient-reported outcomes collected at clinic visits, including substance use and depression, were also available. We used Cox proportional hazards models to determine whether sex modified the association of predictors of interest with incident stroke.
RESULTS
Among 13,573 PWH (19% female sex at birth, mean age 44 years, mean follow-up 5.6 years), female sex was associated with a higher risk of stroke only among individuals aged 50 years or younger (hazard ratio [HR] 2.01 at age 40 [1.25-3.21] vs HR 0.60 at age 60 [0.34-1.06]; = 0.001 for the interaction). Younger female participants who developed a stroke were more likely to have treated hypertension, a higher cardiovascular risk score, and detectable HIV than younger male participants whereas these factors were comparable by sex among older participants who developed a stroke. Sex modified the effect of detectable HIV (HR 4.66 for female participants [2.48-8.74] vs HR 1.30 for male participants [0.83-2.03]; = 0.001 for the interaction), methamphetamine use (HR 4.78 for female participants [1.47-15.56] vs HR 1.19 for male participants [0.62-2.29]; = 0.04 for the interaction), and treated hypertension (HR 3.44 for female participants [1.74-6.81] vs HR 1.66 for male participants [1.14-2.41]; = 0.06 for the interaction) on stroke risk.
DISCUSSION
Younger female participants with HIV were at elevated cerebrovascular risk compared with younger male participants. Several risk factors had a greater adverse effect on stroke risk in female participants than in male participants, including HIV viremia, methamphetamine use, and treated hypertension. These findings underscore the importance of a personalized approach to predict and prevent cerebrovascular risk among PWH.
背景和目的
尽管 HIV 相关的中风风险可能对女性高于男性，但对于 HIV 感染者（PWH）中不同因素对脑血管风险的影响是否因性别而异，以及这些因素是否导致该人群中风风险存在差异，我们知之甚少。本研究的主要目的是探讨在 AIDS 研究网络综合临床系统（CNICS）队列的 PWH 中，性别是否会改变人口统计学、心血管代谢因素、健康相关行为和 HIV 特异性变量对中风风险的影响。
方法
在这项观察性队列研究中，我们分析了来自五个 CNICS 站点的临床就诊数据，时间范围约为 2005 年至 2020 年。所有潜在的中风事件均由神经科医生进行裁决。还可获得在诊所就诊时收集的患者报告结局，包括物质使用和抑郁情况。我们使用 Cox 比例风险模型来确定性别是否改变了感兴趣的预测因素与中风事件的关联。
结果
在 13573 名 PWH 中（出生时女性占 19%，平均年龄 44 岁，平均随访时间为 5.6 年），仅在年龄为 50 岁或以下的个体中，女性的中风风险更高（年龄为 40 岁时的风险比[HR]为 2.01 [1.25-3.21]，年龄为 60 岁时的 HR 为 0.60 [0.34-1.06]；性别间差异有统计学意义， = 0.001）。年龄较小的女性中风患者更有可能接受高血压治疗、心血管风险评分更高和 HIV 可检测，而年龄较大的女性患者在这些因素方面与男性患者无差异。性别改变了可检测 HIV（女性患者的 HR 为 4.66 [2.48-8.74]，男性患者的 HR 为 1.30 [0.83-2.03]；性别间差异有统计学意义， = 0.001）、使用冰毒（女性患者的 HR 为 4.78 [1.47-15.56]，男性患者的 HR 为 1.19 [0.62-2.29]；性别间差异有统计学意义， = 0.04）和接受高血压治疗（女性患者的 HR 为 3.44 [1.74-6.81]，男性患者的 HR 为 1.66 [1.14-2.41]；性别间差异有统计学意义， = 0.06）对中风风险的影响。
讨论
与年轻男性患者相比，年龄较小的女性 HIV 感染者的脑血管风险更高。一些危险因素对女性患者的中风风险影响更大，包括 HIV 病毒载量、冰毒使用和高血压治疗。这些发现强调了针对 PWH 预测和预防脑血管风险采用个性化方法的重要性。
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