Stroke in HIV infected patients. Is it more frequent and are they attended worse?
Ana de Arce(1), Miguel Angel Goenaga(2), Patricia de la Riva, Félix Gonzalez, Noemí Díez, Maialen Arruti, Miguel Angel Von Wichmann De Miguel , Francisco Rodriguez-Arrondo, Xabier Camino Ortiz, María Jesus Bustinduy Odriozola, Harkaitz Azkune Galparsoro, Maialen Ibarguren Pinilla, Xabier Kortajarena Urkola, Amaia Muñoz-Lopetegi, Gorka Fernández-Eulate, Jon Rodriguez-Antigüedad, David Campo-Caballero, Jose Antonio Iribarren Loyarte, M.Teresa Martinez de Albéniz.
Background and objectives: It is believed that HIV-infected patients have a higher risk of stroke and that they receive a different acute phase attention. The aim of this study is to determine if this is true in our environment.
Methods: Retrospective analysis of a series of cases of stroke in a HIV population in Gipuzkoa since 2009. The attention in the emergency room and the reason for not been admitted in the stroke unit (SU) are analized when this occurs.
Results: 30 patients were included (mean age 56 years, range 45-80), 80% male, and an incidence of 3.04 cases per 1000 patient-year. Baseline characteristics: Parenteral drug use (67%), HBP (46%), smoke (63%), mean CD4 of 665 cells with undetectable viral load in 83%. 67% were ischemic stroke (IS) and 33% hemorrhagic stroke (HS). 50% of IS and 20% of HS were admitted to the SU. No thrombolysis or thrombectomy was performed and mortality at discharge was 25% in IS and 60% in HS. The reason for not entering the stroke unit were: >24h from the beginning of symptoms (39%) and coma or need of orotracheal intubation (28%). In 22%, no neurological care was requested despite fullfilling criteria for admission to the stroke unit.
Conclusions: HIV-infected patients have an increased incidence of stroke at younger ages. In our enviroment, the main reason for not entering stroke units is a delay in the search of care. It would be advisable to implement health education on early detection of stroke in this population.