Stroke Outcomes in Malawi, a Country with High Prevalence of HIV: A Prospective Follow-Up Study

Abstract

BackgroundStroke contributes significantly to disability and mortality in developing countries yet little is known about the determinants of stroke outcomes in such countries. 12% of Malawian adults have HIV/AIDS. It is not known whether having HIV-infection alters the outcome of stroke. The aim of this study was to document the functional outcome and mortality at 1 year of first-ever acute stroke in Malawi. Also to find out if the baseline variables, including HIV-infection, affect the outcome of stroke.Methods and Findings147 adult patients with first-ever acute stroke were prospectively followed up for 12 months. Conventional risk factors and HIV-infection were assessed at baseline. Stroke severity was evaluated with modified National Institute of Health Stroke Scale (mNIHSS) and functional outcome with modified Rankin scale (mRS). Fifty (34%) of patients were HIV-seropositive. 53.4% of patients had a poor outcome (severe disability or death, mRS 4–6) at 1 year. Poor outcome was related to stroke severity and female gender but not to presence of HIV-infection. HIV-seropositive patients were younger and had less often common risk factors for stroke. They suffer more often ischemic stroke than HIV-seronegative patients.ConclusionsMild stroke and male gender were associated with favourable outcome. HIV-infection is common in stroke patients in Malawi but does not worsen the outcome of stroke. However, it may be a risk factor for ischemic stroke for young people, who do not have the common stroke risk factors. Our results are significant, because stroke outcome in HIV-seropositive patients has not been studied before in a setting such as ours, with very limited resources and a high prevalence of HIV.

Quality of Life after First-Ever Stroke: An Interview Based Study from Blantyre, Malawi

“…This was a substudy of the Stroke Outcomes in Malawi (SOMA) study 16 , which was conducted by the Queen Elizabeth Central Hospital (QECH, Blantyre) medical department from August 2008 until April 2010. Patients were eligible for SOMA if they were aged 18 years or older and had a first-ever acute stroke within seven days before admission.…”

“…Patients without brain imaging were defined as having an undetermined stroke type. More detailed methods for case management, baseline assessment, and follow-up for the SOMA study are explained elsewhere 16 .…”

“…These categories are: total anterior circulation syndrome (TACS), partial anterior circulation syndrome (PACS), posterior circulation syndrome (POCS), and lacunar syndrome (LACS). The National Institute of Health Stroke Scale (NIHSS) 16,18 was used to assess stroke severity at the acute phase. The NIHSS was modified (mNIHSS) for the local setting: because people do not always know their age, the name of the current president of Malawi was asked instead.…”

Immune Dysfunction in HIV infected stroke patients: Role of low CD₄ counts

“…Additionally, observational studies in other developing countries have suggested an association between immune dysfunction and stroke based on increased hospital admissions for young immunosuppressed HIV-positive patients with ischemic stroke in the absence of other obvious risk factors of ischemic stroke. (Tipping et al, 2007a;Heikinheimo et al, 2012). This suggests the role of degree of immunosuppression as a determinant of development of neurological manifestation of HIV/AIDS.…”

Intracranial vascular complications in AIDS

“…По данным исследований [22,46] -(39±8) лет. Одна из возможных причин уменьшения возраста пациентов с ВИЧ-инфекцией -отсутствие или недостаточность АРВТ [47,48].…”