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Table 3 Published studies on stroke in PLWH in sub-Saharan Africa

From: The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review

Study
(location, dates)
Study Design N = Age (years)a ART-status Findings
Study population: stroke patients
Patel et al. [116]
(SA, 1987-2002)
Retrospective case-controlb PLWH: 56
HIV-: 154
15-44 100% ART-naïve • No significant differences between PLWH and HIV- patients with stroke regarding cardiac etiologies or angiography
Hoffmann et al. [117]
(SA, 1992-98)
Prospective case-controlb PLWH: 22
HIV-: 23
29.1 (20-42)
31.0 (19-44)
100% ART-naïve • PLWH with fewer traditional CVD risk factors
• 20 of 22 (91%) PLWH with unknown etiology for stroke
• All PLWH were diagnosed with HIV at admission for stroke
Mochan et al. [114]
(SA, 1999-2000)
Case series of PLWH and stroke PLWH: 35 32.1 (20-61) 100% ART-naïve • 94% ischemic; 6% hemorrhagic
• LP showed infection in 10 of 33 PLWH
• 17 PLWH had coagulopathy
Tipping et al. [113]
(SA, 2000-06)
Prospective cohort of stroke patients PLWH: 67
HIV-: 1020 (all subjects)
PLWH: 61 HIV-: 205 (<46y)
33.4 (19-76)
64 (17-96)
12% < 6 months ART
88% ART-naïve
• 96% ischemic; 4% hemorrhagic
• ID etiologies predominant among PLWH (37% vs 8%)
• 20% of PLWH had HIV vasculopathy
• Fewer traditional risk factors among PLWH <46 years
Kumwenda et al. [112]
(Malawi, 2001-02)
Prospective case-control PLWH: 47
HIV-: 51
37.5 ± 13.1
58.6 ± 16.8
100% ART-naïve • 11 (23%) of PLWH diagnosed with infectious etiologies of stroke
Heikinheimo et al. [115]
(Malawi, 2008-09)
Cohort of 1st time stroke PLWH: 50
HIV-: 84
39.8 ± 12.4
61.9 ± 14.0
22% on ART • No difference in outcomes between PLWH and HIV-
• PLWH were younger with fewer CVD risk factors
Owolabi et al. [37]
(Nigeria, 2008-10)
Prospective cohort of stroke patients (18-40 years) PLWH: 6
HIV-: 65
31.9 ± 6 Not stated • 8.5% were PLWH but not all patients were tested
• HIV is 5th most common risk factor
Study population: PLWH
Longo-Mbenza et al. [134] (DRC, 2004-08) Cross-sectional PLWH: 116 45.3 ± 8.5 (men)
42.5 ± 11.2 (women)
100% of stroke patients on ART • 17 (15%) PLWH had stroke
• 94% ischemic; 6% ICH
• Uncertain ID workup
• Fewer traditional risk factors among stroke patients, but lower CD4 and more WHO Stage 3-4
Divala et al. [135]
(Malawi, 2014)
Cross-sectional PLWH: 952 43.0 ± 10.2 4.1% ART-naïve
95.9% on ART
• Self-reported past stroke: 4.3%
Study population: stroke (cases) and non-stroke from community (controls)
Walker et al. [118]
(Tanzania, 2003-06)
Case-controlb Stroke: 201
(PLWH: 25)
Controls: 398
(PLWH: 15)
61.7 (15.0) and 68.8 (14.8)c
61.4 (13.1) and 69.4 (14.6)c
100% ART-naïve • Stroke associated with traditional risk factors
• HIV independently associated with stroke (aOR, 5.61)
Benjamin et al. [136]
(Malawi, 2011-12)
Case-controld Stroke: 222
(PLWH: 69)
Controls: 503
(PLWH: 95)
60 (42-70)
57 (42-67)
17% ART-naïve
7% ART <6 mo
6% ART ≥6 mo
9% ART-naïve
1% ART <6 mo
8% ART ≥6 mo
• 78% ischemic; 22% hemorrhagic
• Stroke associated with HIV (aOR, 3.28), especially if ART started in past 6 months (aOR, 15.6)
• No effect modification for HIV and HTN
• Diabetes and smoking were independently associated
Asiki et al. [137]
(Uganda, not stated)
Retrospective case-controlb Stroke: 31
(PLWH: 5)
Controls: 135
(PLWH: 8)
59.0 (13.7)
60.2 (13.7)
62% of PLWH are ART-naïve • Increased risk of stroke among HIV+ (16% vs 6%)
• Potentially biased sample given patients included only if they had frozen specimen available for varicella IgG testing
Mochan et al. [138]
(SA, not stated)
Case-controle Stroke: 33
(PLWH: 33)
Controls: 66
(PLWH: 33)
32.1 (20-61) Not stated • Protein S deficiency associated with HIV, not stroke
  1. amean ± SD or median (IQR)
  2. bmatched by age/sex
  3. ctwo study regions (Dar-es-Salaam and Hai)
  4. dmatched by age, sex, socioeconomic status, season of admission
  5. ematched by age, sex, and CD4
  6. PLWH people living with HIV, SA South Africa, ART antiretroviral therapy, LP lumbar puncture, ID infectious disease, DRC Democratic Republic of Congo, ICH intracerebral hemorrhage, WHO World Health Organization, aOR adjusted odds ratio, HTN hypertension
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