Updated guidelines for the use of antiretroviral agents in adults and adolescents mention a treatment-associated stroke risk.

The Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents issued the new guidelines earlier this year. Key changes from the December 2009 version address CD4 count monitoring, viral load testing, drug-resistance testing, initial combination regimens for first-time users of antiretroviral agents, hepatitis B coinfection, and tuberculosis coinfection.

MI and stroke have been associated with the use of protease inhibitors in some cohort studies, with the greatest risk carried by persons with traditional risk factors for cardiovascular disease. And now, a study by Bruce Ovbiagele, MD, MSc, and Avindra Nath, MD — published online by Neurology — supports that idea that HIV treatments or perhaps HIV infection itself may lead to stroke.

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The study found that actual numbers of overall U.S. stroke hospitalizations decreased by 7% from 1997 to 2006, but actual numbers of stroke hospitalizations with coexisting HIV infection increased by 60%. In 1997, 0.08% of ischemic strokes were seen in persons with HIV; in 2006, that percentage had risen to 0.18%. No change was seen in proportion of HIV patients with hemorrhagic stroke from 1997 to 2006.

Dr. Ovbiagele commented in a separate statement that the increasingly widespread use of combination antiretroviral agents in HIV patients may boost the presence of risk factors associated with stroke. “Another possibility is that longer exposure to HIV as a result of greater survival, even at low viral load levels, may allow for the virus to increase stroke risk,” he noted.