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

Eur J Neurol. 2014 Nov;21(11):1394-9. doi: 10.1111/ene.12506. Epub 2014 Jul 10.

Abstract

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.

Keywords: HIV; cerebral infarction; cerebrovascular diseases and cerebral circulation; infections; neurological disorders; stroke; thrombolysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravenous
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / mortality*
  • Comorbidity
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / mortality*
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Stroke / drug therapy*
  • Stroke / epidemiology
  • Stroke / mortality*
  • Tissue Plasminogen Activator / pharmacology*
  • Treatment Outcome
  • Young Adult

Substances

  • Tissue Plasminogen Activator