Risk of intracerebral hemorrhage in HIV/AIDS: a systematic review and meta-analysis

Evidence for the association and the increased risk of stroke with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is growing. Recent studies have reported on HIV infection as a potent risk factor for intracerebral hemorrhage (ICH). We used the pooled results from case–control studies to conduct a systematic review and a meta-analysis in order to evaluate the risk of ICH with HIV/AIDS. Our systematic review and meta-analysis was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm of all available case–control studies that reported on the risk of ICH in patients with HIV/AIDS. Five eligible studies were identified, totaling 5,310,426 person-years studied over various periods that ranged from 1985 to 2010. There were a total of 724 cases of ICH, 138 with HIV/AIDS. HIV-infected ICH patients were in average younger. Pooled crude incidence rate ratio (IRR) for ICH in HIV/AIDS patients was 3.40 (95 % confidence intervals [CI] 1.44–8.04; p = 0.005, random-effects model). Clinical AIDS was associated with a higher IRR of ICH (11.99, 95 % CI 2.84–50.53; p = 0.0007) than HIV+ status without AIDS (1.73, 95 % CI 1.39–2.16; p < 0.0001). Patients with CD4⁺ lymphocyte count <200 cells/mm³ were similarly at a higher risk. Antiretroviral therapy did not seem to increase the risk of ICH. The available evidence suggests that HIV/AIDS is an important risk factor for ICH, particularly in younger HIV-infected patients and those with advanced disease.