<h2>ABSTRACT</h2><h3>Objective</h3> To compare risk factors and clinical outcomes between people living with HIV (PLWH) and HIV-uninfected (HIV-) adults with stroke hospitalized in Zambia. <h3>Methods</h3> Weretrospectively reviewed charts of all adults admitted to the University Teaching Hospital in Lusaka, Zambia with a clinical diagnosis of stroke between October 2018 and March 2019. Standardized data collection instruments were used to collect demographic, clinical, laboratory and imaging results. Comparison between individuals with and without HIV infection was made using t-tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous non-parametric variables, and chi-square analyses for categorical variables. <h3>Results</h3> 272adults with stroke were admitted of whom 58 (21%) were PLWH. Compared to HIV- participants, PLWH were younger (48 ± 14) years versus 62 ± 18) years, p<0.001). PLWH were less likely to have hypertension (65% vs 83%, p=0.003) and more likely to have no traditional cerebrovascular risk factors (34% vs 15%, p=0.01). Deep vein thrombosis (DVT) (4% vs 1%, p=0.04) was more common during hospitalization amongst PLWH, but there was no difference in in-hospital mortality (21% vs 23%, p=0.65). Among PLWH with stroke, factors associated with in-hospital mortality were Glasgow Coma Scale (GCS) on admission (7 vs 10, p=0.046), hypertension (92% vs 59%, p=0.04) and fever (58% vs 13%, p=0.003). <h3>Conclusion</h3> This Zambian cohort of PLWH and stroke is notable for being significantly younger with fewer traditional stroke risk factors but higher rates of DVT than their HIV-uninfected counterparts. GCS on admission, hypertension and fever were associated with in-hospital mortality.