Louis Kroon1, Daniel G van Zyl2, Clara M Schutte3, Christine Smit4, Juliane Hiesgen5. 1. Department of Neurology, University of Pretoria, South Africa. 2. Department of Internal Medicine, University of Pretoria, South Africa. Electronic address: danie.vanzyl@up.ac.za. 3. Department of Neurology, University of Pretoria, South Africa,. Electronic address: clara.schutte@up.ac.za. 4. Department of Neurology, University of Pretoria, South Africa,. Electronic address: smitc11@telcom.co.za. 5. Department of Neurology, University of Pretoria, South Africa,. Electronic address: juliane.hiesgen@up.ac.za.
Abstract
OBJECTIVES: Low- to middle-income countries experience a marked rise in cardiovascular diseases, and have the highest incidence of HIV infection. Stroke data in HIV-positive patients is still scarce. This study compares risk factors and types of stroke between HIV-positive and -negative patients in South Africa. MATERIALS AND METHODS: We conducted a cross-sectional study at Kalafong Provincial Tertiary Hospital in Pretoria over a 10-month period. All adult patients presenting with an acute stroke were included. RESULTS: One hundred and forty consecutive patients with stroke were included, 23% were HIV-positive. The average age in the HIV-positive group was 41 years, compared to 61 years in the HIV-negative group (p < 0.01). Ischemic infarcts occurred in 80.7 and 19.3% were hemorrhagic, with no significant difference between the HIV-positive and -negative group (ischemic: 81% vs 80%; hemorrhagic: 19% vs 20%; p = 0.55). Small vessel infarcts occurred more frequently in HIV-positive patients (25% vs 9.3%; p < 0.02). While 78% of HIV-positive patients presented with concomitant infections, these were found in only 23% of HIV-negative patients (P < 0.001). Hypertension (81% vs 37.5%; p = 0.01) and dyslipidemia (62% vs 38%; p = 0.01) were more prevalent in the HIV-negative patients. Confounding variables were gender and age. Although more than half of the HIV-positive patients were on antiretroviral therapy, the majority (62.5%) showed virological non-suppression. CONCLUSIONS: HIV infection occurred in almost one-quarter of stroke patients and was seen more in the younger age group. Small vessel ischemic infarcts and underlying infections were more common in HIV-positive patients. The high number of HIV-positive patients with virological non-suppression is concerning and needs to be addressed.
OBJECTIVES: Low- to middle-income countries experience a marked rise in cardiovascular diseases, and have the highest incidence of HIV infection. Stroke data in HIV-positive patients is still scarce. This study compares risk factors and types of stroke between HIV-positive and -negative patients in South Africa. MATERIALS AND METHODS: We conducted a cross-sectional study at Kalafong Provincial Tertiary Hospital in Pretoria over a 10-month period. All adult patients presenting with an acute stroke were included. RESULTS: One hundred and forty consecutive patients with stroke were included, 23% were HIV-positive. The average age in the HIV-positive group was 41 years, compared to 61 years in the HIV-negative group (p < 0.01). Ischemic infarcts occurred in 80.7 and 19.3% were hemorrhagic, with no significant difference between the HIV-positive and -negative group (ischemic: 81% vs 80%; hemorrhagic: 19% vs 20%; p = 0.55). Small vessel infarcts occurred more frequently in HIV-positive patients (25% vs 9.3%; p < 0.02). While 78% of HIV-positive patients presented with concomitant infections, these were found in only 23% of HIV-negative patients (P < 0.001). Hypertension (81% vs 37.5%; p = 0.01) and dyslipidemia (62% vs 38%; p = 0.01) were more prevalent in the HIV-negative patients. Confounding variables were gender and age. Although more than half of the HIV-positive patients were on antiretroviral therapy, the majority (62.5%) showed virological non-suppression. CONCLUSIONS:HIV infection occurred in almost one-quarter of strokepatients and was seen more in the younger age group. Small vessel ischemic infarcts and underlying infections were more common in HIV-positive patients. The high number of HIV-positive patients with virological non-suppression is concerning and needs to be addressed.
Authors: Craig Corbett; Naeem Brey; Richard D Pitcher; Suzanne O'Hagan; Tonya M Esterhuizen; Felicia C Chow; Eric H Decloedt Journal: Neurology Date: 2022-06-03 Impact factor: 11.800
Authors: Amir A Mbonde; Jonathan Chang; Abdu Musubire; Samson Okello; Adrian Kayanja; Moses Acan; Jacob Nkwanga; Andrew Katende; Felicia C Chow; Deanna Saylor; Cumara O'Carroll; Mark J Siedner Journal: J Stroke Cerebrovasc Dis Date: 2022-04-25 Impact factor: 2.677