Increased Risk of Neurological Disorders Among Persons with HIV: A Case-Control Analysis
Samantha Dolter1, Jeffrey Bakal2, Raynell Lang3, Bohdan Savaryn1, John Gill3, Yuan Dong2, Christopher Power1
1University of Alberta - Department of Medicine, 2Alberta SPOR Support Unit, Provincial Research Data Services, Alberta Health Services, 3University of Calgary - Department of Medicine
Objective:
This study investigated the frequency of neurological disorders and outcomes among persons with HIV (PWH) seen in specialty clinics in the province of Alberta, Canada.
Background:
Despite universal access to ART at no cost to patients for over 25 years, PWH remain at increased risk of neurologic disorders including dementia, stroke, and seizures. We present data derived from health records in Alberta, Canada from 2004-2023.
Design/Methods:
Alberta maintains a population-based province-wide electronic medical record database encompassing over 7 million patient-years. Using health services data from this database, along with linked electronic sources, we created a case-control cohort (1:4) including PWH (n=8778) with age-, sex-, and Charlson comorbidity-matched persons without HIV (PWOH) (n=35,112. Most PWH received ARTs, however some may have been untreated or undertreated. Neurologic disorder frequency and death were examined in both groups by searching ICD-9 and -10 codes for dementia, stroke, seizures, and death. P-values were determined using chi-square test.
Results:
Among PWH, the risk of death throughout the study timeframe was 16.95% compared to 5.41% among PWOH (p<0.0001). PWH showed greater likelihood of developing dementia (2.57%) compared to PWOH (0.83%) (p<0.0001). More PWH (4.57%) experienced seizures versus PWOH (1.33%) (p<0.0001). In contrast, risk of all stroke types in PWH (1.18%) was comparable to PWOH (1.16%) (p=0.8589).
Conclusions:
These data represent one of the largest case-control studies of neurologic disorder rates in PWHs reported to date. PWH in our study were at greater risk of death (3-fold), though we found a steady decline in mortality over the study period. PWH were also at higher risk of seizures (3-fold), and dementia (3-fold). Unexpectedly, there was no difference between PWH and PWOH in stroke frequency when controlling for comorbidities. Our study quantifies the increased risk of neurological disorders among PWH, emphasizing the importance of vigilance regarding neurological diseases in PWH.
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