Ten-year stroke rate was almost 2 times higher in HIV-positive US men who have sex with men (MSM) than in HIV-negative MSM, and the Framingham Risk Score underestimated stroke risk in men with HIV.
Previous research identified a higher stroke incidence in men and women with HIV than in the general population, independently of traditional stroke risk factors (Chow FC, et al. JAIDS. 2012; 60: 351-358). To determine stroke incidence and Framingham predictive value, researchers working with the US Multicenter AIDS Cohort Study (MACS) conducted this analysis.
MACS is an ongoing cohort study involving HIV-positive and negative MSM in four US cities. Men make twice-yearly visits for health evaluations and interviews. For this analysis, MACS investigators determined how many men had a stroke during a 15-year period, from 1 July 1996 to 30 June 2011. For men who had a stroke, the MACS team calculated the Framingham stroke risk score 10 years before the stroke occurred.
The analysis involved 1776 MSM with HIV and 2169 HIV-negative MSM. During the study window, 57 HIV-positive men and 37 HIV-negative men had a stroke, 19 of which were fatal. Incidence of first-ever stroke was 1.7 per 1000 person-years in HIV-negative men and 3.3 per 1000 person-years in HIV-positive men.
When the strokes occurred, HIV-positive MSM were significantly younger than HIV-negative men (median 51.3 versus 61.8 years, P < 0.0001).