HIV infection does not influence stroke outcomes in HIV-infected patients: A prospective study

Mapoure, Yacouba Njankouo; Mondomobe, C.A. Atchom; Nkouonlack, Cyrille; Ayeah, Chia Mark; Luma, Henry Namme; Njamnshi, Alfred K.

doi:10.1016/j.neurol.2018.09.020

Cited by 5 publications

(8 citation statements)

References 9 publications

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“…Once the HIV+ participants were medically stable, they made good recovery and scored in the higher percentiles, compared to other groups (see Table 2). However, as in previous studies, this study showed no significant functional differences between groups on admission, or on discharge, for any of the functional outcome measures (see Table 2) (Heikinheimo et al 2012;Kumwenda et al 2005;Mapoure et al 2019;Mlay & Bakari 2012). With previous studies based at acute care facilities and researchers utilising global outcome measures, an appropriate comparison could not be made.…”

Section: Potential Barriers and Preliminary Comparative Findingscontrasting

confidence: 52%

“…Furthermore, the outcome measures used to assess function were often global in nature and lacked specificity and sensitivity to describe all aspects of function adequately (Schepers et al 2007). Previous African studies in Malawi (Heikinheimo et al 2012) and Cameroon (Mapoure et al 2019) compared the functional outcome of HIV+ and HIVstroke inpatients. These studies, as other international studies, used the modified Rankin scale and reported no significant difference in function between the groups.…”

Section: Introductionmentioning

confidence: 99%

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Functional outcome of stroke inpatients according to human immunodeficiency virus status: A feasibility study

Hartley

Burger

Esterhuizen

et al. 2020

African Journal of Disability

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This feasibility study aims to determine the requirements for a large descriptive cohort, to adequately describe the functional outcome of stroke patients with varying HIV status.Method: All stroke patients meeting the inclusion criteria were recruited over a 6-month period at a South African inpatient rehabilitation centre. Data were collected on admission and discharge using outcome measures including the Barthel Index (BI), Berg Balance Scale (BBS) and the use of assistive devices used to describe independence with activities of daily living (ADL), mobility and safety post-stroke. Statistical analysis was performed using Stata version 14.2. Results:The feasibility study identified appropriate procedures and barriers to a successful study in addition to describing preliminary data on participant demographics, relevant medical history and functional outcomes post-stroke. Limitations that affected feasibility included minimal recruitment sites, length of data collection period, timely communication of participant discharge plans and dates, and confirmation of participant HIV status. An appropriate comparison between sub-groups could not be made because of disproportionate group sizes, median age differences and no assessor blinding. Conclusion:To increase generalisability and the understanding of the unique HIV+ stroke profile, multiple recruitment sites, longer data collection periods, assessor blinding and agematched groups with HIV status confirmation are recommended.

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Section: Potential Barriers and Preliminary Comparative Findingscontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Functional outcome of stroke inpatients according to human immunodeficiency virus status: A feasibility study

Hartley

Burger

Esterhuizen

et al. 2020

African Journal of Disability

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“…HIV prevalence among women in Cameroon is higher (3.4%) than among men (1.9%) [ 14 ]. In a hospital study in Cameroon, men were more likely to be found among PLWH with stroke [ 19 ]. In the literature, there is variability according to sex, with the majority of studies favoring a male preponderance [ 19 - 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a hospital study in Cameroon, men were more likely to be found among PLWH with stroke [ 19 ]. In the literature, there is variability according to sex, with the majority of studies favoring a male preponderance [ 19 - 21 ]. Nevertheless, it is demonstrated that women living with HIV have a higher immune activation in than seronegative women and men [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular risk and stroke mortality in persons living with HIV: a longitudinal study in a hospital in Yaounde

et al. 2021

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Introduction HIV infection is a well-known risk factor for stroke, especially in young adults. In Cameroon, there is a death of data on the outcome of stroke among persons living with HIV (PLWH). This study aimed to assess the cardiovascular risk profile and mortality in PLWH who had a stroke. Methods this was a retrospective cohort study of all PLWH aged ≥18 years admitted for stroke between January 2010 and December 2019 to the Cardiology Unit of the Yaoundé Central Hospital, Cameroon. Cardiovascular risk was estimated using the modified Framingham score, with subsequent dichotomization into low and intermediate/high risk. Mortality was assessed on day 7 during hospitalization (medical records), at one month, and one year by telephone call to a relative. Results a total of 43 PLWH who had a stroke were enrolled. Their mean age was 52.1 (standard deviation 12.9) years, most of them were female (69.8%, n = 30). There were 25 (58.1%) patients on concomitant antiretroviral therapy. The Framingham cardiovascular risk score at admission was low in 29 patients (67.4%) and intermediate to high in 14 patients (32.6%). Ischemic stroke was the most common type of stroke in 36 persons (83.7%). The length of hospital stay was 11.4 (interquartile range 9.2-13.7) days. Mortality at 1 year was 46.5% (n = 20). Conclusion stroke mortality was high in this population of PLWH. Most patients had a low Framingham score, suggesting that this risk estimation tool underestimates cardiovascular risk in PLWH.

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“…21,25 A possible increased morbidity and mortality for HIV-associated stroke patients is still uncertain, with multiple studies finding dissimilar outcomes. 2,21,22,[25][26][27] In summary, while there has been greater ART access in the high-prevalence subtype C HIV population from South Africa, HIV-associated stroke prevalence data in the ART era are limited. Moreover, there is a paucity of updated information on differences in these patients with unadjusted age as a major confounder.…”

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confidence: 99%

Prevalence and Characteristics of HIV-Associated Stroke in a Tertiary Hospital Setting in South Africa

et al. 2022

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Background and Objectives:Antiretroviral 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.Methods:We conducted a retrospective study of adults presenting with any type of stroke to Tygerberg Hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected patients (HIV-) were matched on age group (1:2 ratio). Patients were identified by keyword search, while HIV status was ascertained from laboratory data. Clinical and imaging data were extracted from medical records.Results:Among 884 patients presenting with acute strokes, the minimum prevalence of HIV infection was 9.3% (95% CI: 7.4-11.2%), with 496 patients (56.1%) with negative HIV status and 306 patients with unknown HIV status (34.6%). Mean age at presentation in PLWH was 46 (± 11) years compared to 55 (± 14) years in HIV- (p<0.001). Smoking was less prevalent in PLWH with an adjusted relative risk of RR=0.58 (95% CI: 0.39–0.86). Concurrent infection was more prevalent in PLWH (25.6% vs 4.9%, p=<0.001) with an adjusted relative risk ratio of 2.07 (95% CI: 1.49–2.84), largely in patients with CD4 count <200 cells/mcL. PLWH with higher CD4 counts (≥200 cells/mcL, 51.3%) had more traditional risk factors and less concurrent infection. Among PLWH, 68.3% were on ART, and 39.3% of these had been started or restarted on ART within the past 6-months. Basal ganglia infarcts (35.6% vs 18.3%, p=0.014) and multiple vascular territory involvement (25.4% vs 7.7%, p=0.002) was more common in PLWH. Clinical presentation, ischaemic stroke type, and in-hospital outcomes did not differ between groups.Conclusion:Stroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV, especially those with a lower CD4 count. 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, including associated infections and potential ART-associated immune reconstitution, is crucial and needs further study.

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HIV infection does not influence stroke outcomes in HIV-infected patients: A prospective study

Cited by 5 publications

References 9 publications

Functional outcome of stroke inpatients according to human immunodeficiency virus status: A feasibility study

Functional outcome of stroke inpatients according to human immunodeficiency virus status: A feasibility study

Cardiovascular risk and stroke mortality in persons living with HIV: a longitudinal study in a hospital in Yaounde

Prevalence and Characteristics of HIV-Associated Stroke in a Tertiary Hospital Setting in South Africa

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