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Sex Differences in the Risk of Stroke Associated With Traditional and Non-Traditional Factors in a US Cohort of People With HIV Infection.
Chow, Felicia C; Nance, Robin M; Becker, Kyra; Ho, Emily L; Huffer, Andrew; Kalani, Rizwan; Marra, Christina M; Zunt, Joseph R; Bamford, Laura; Burkholder, Greer A; Cachay, Edward; Eron, Joseph J; Keruly, Jeanne; Kitahata, Mari M; Napravnik, Sonia; Saag, Michael S; Willig, Amanda L; Moore, Richard D; Tirschwell, David L; Delaney, Joseph A; Crane, Heidi M.
Afiliación
  • Chow FC; 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 W
  • Nance RM; 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 W
  • Becker K; 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 W
  • Ho EL; 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 W
  • Huffer A; 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 W
  • Kalani R; 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 W
  • Marra CM; 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 W
  • Zunt JR; 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 W
  • Bamford L; 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 W
  • Burkholder GA; 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 W
  • Cachay E; 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 W
  • Eron JJ; 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 W
  • Keruly J; 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 W
  • Kitahata MM; 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 W
  • Napravnik S; 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 W
  • Saag MS; 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 W
  • Willig AL; 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 W
  • Moore RD; 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 W
  • Tirschwell DL; 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 W
  • Delaney JA; 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 W
  • Crane HM; 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 W
Neurology ; 103(4): e209726, 2024 Aug 27.
Article en En | MEDLINE | ID: mdl-39088772
ABSTRACT
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]; p = 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]; p = 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]; p = 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]; p = 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.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Infecciones por VIH / Accidente Cerebrovascular Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Neurology Año: 2024 Tipo del documento: Article
Texto completo
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PubMed Links
Buscar en Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Infecciones por VIH / Accidente Cerebrovascular Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Neurology Año: 2024 Tipo del documento: Article