Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV-infected adults

• Published in: European journal of neurology Vol. 21; no. 11; pp. 1394 - 1399
• Main Authors: Sweeney, E. M., Thakur, K. T., Lyons, J. L., Smith, B. R., Willey, J. Z., Cervantes-Arslanian, A. M., Hickey, M. K., Uchino, K., Haussen, D. C., Koch, S., Schwamm, L. H., Elkind, M. S. V., Shinohara, R. T., Mateen, F. J.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2014; John Wiley & Sons, Inc
• Subjects: Administration, Intravenous; Adolescent; Adult; Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Brain Ischemia - epidemiology; Brain Ischemia - mortality; cerebral infarction; cerebrovascular diseases and cerebral circulation; Comorbidity; Female; HIV; HIV Infections - epidemiology; HIV Infections - mortality; Hospital Mortality; Humans; infections; Male; Middle Aged; neurological disorders; stroke; Stroke - drug therapy; Stroke - epidemiology; Stroke - mortality; thrombolysis; Tissue Plasminogen Activator - pharmacology; Treatment Outcome; Young Adult; HIV; cerebral infarction; cerebrovascular diseases and cerebral circulation; neurological disorders; infections; thrombolysis; stroke
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.12506

Background and purpose To our knowledge there are no studies reporting the use and short‐term outcomes of intravenous tissue plasminogen activator (IV‐TPA) for the treatment of acute ischaemic stroke (AIS) in people living with HIV. Methods The US Nationwide Inpatient Sample (NIS) (2006–2010) was searched for HIV‐infected AIS patients treated with IV‐TPA. Results In the NIS, 2.2% (62/2877) of HIV‐infected AIS cases were thrombolyzed with IV‐TPA (median age 52 years, range 27–78, 32% female, 22% Caucasian) vs. 2.1% (19 335/937 896) of HIV‐uninfected cases (median age 72 years, range 17–102 years, 50% female, 74% Caucasian; P = 0.77). There were more deaths in HIV‐infected versus uninfected patients with stroke (220/2877, 7.6% vs. 49 089/937 547, 5.2%, P < 0.001) but no difference in the proportion of deaths amongst IV‐TPA‐treated patients. The age‐ and sex‐adjusted odds ratio for death following IV‐TPA administration in HIV‐infected versus uninfected patients was 2.26 (95% CI 1.12, 4.58), but the interaction on mortality between HIV and IV‐TPA use was not statistically significant, indicating no difference in risk of in‐hospital death by HIV serostatus with IV‐TPA use. A higher number of HIV‐infected patients remained in hospital versus died or were discharged at both 10 and 30 days (P < 0.01 at 10 and 30 days). No difference in the proportion of intracerebral hemorrhage in the two groups was found (P = 0.362). Conclusions The in‐hospital mortality is higher amongst HIV‐infected AIS patients than HIV‐uninfected patients. However, the risk of death amongst HIV‐infected patients treated with IV‐TPA is similar to HIV‐uninfected groups.