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