PREVALENCE AND CHARACTERISTICS OF HIV-ASSOCIATED STROKE IN A TERTIARY HOSPITAL SETTING IN SOUTH AFRICA

Abstract

Background and AimsAntiretroviral treatment (ART) era HIV-associated stroke data from Sub-Saharan Africa is limited. We determined the prevalence of HIV in patients presenting with acute symptomatic stroke; and compared risk factors, clinical characteristics, and brain imaging with age-matched stroke patients without HIV. MethodsWe conducted a retrospective study of adults presenting with any type of stroke to a South African tertiary hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected patients (HIV-) were matched on age group (1:2 ratio). ResultsTheacute stroke prevalence of HIV infection was 9.3% (95%CI: 7.4-11.2%) among 884 stroke patients. Mean age at presentation in PLWH was 46 (±11) years compared to 55 (±14) years in HIV- (p<0.001). Hypertension (p=0.011) and dyslipidaemia (p=0.005) were less prevalent in PLWH. Concurrent infection was more prevalent in PLWH (p=<0.001), largely in patients with low CD4 counts. PLWH with higher CD4 counts had traditional risk factors and less concurrent infection. Among PLWH, 39.3% had been started / restarted on ART within 6-months. Basal ganglia infarcts (p=0.014) and multiple vascular territory involvement (p=0.002) was more common in PLWH. Clinical presentation, ischaemic stroke type, and in-hospital outcomes did not differ between groups. ConclusionStroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV when CD4 count was low. Recent ART initiation or reinitiation rates were high. Significant differences in CT brain imaging findings were seen. Understanding the multifactorial mechanisms underlying increased stroke risk in this population is crucial.