HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults A case-control study


Benjamin, Laura A ORCID: 0000-0002-9685-1664, Corbett, Elizabeth L, Connor, Myles D, Mzinganjira, Henry, Kampondeni, Sam, Choko, Augustine, Hopkins, Mark, Emsley, Hedley CA, Bryer, Alan, Faragher, Brian et al (show 3 more authors) (2016) HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults A case-control study. NEUROLOGY, 86 (4). pp. 324-333.

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Abstract

Objective: To investigate HIV, its treatment, and hypertension as stroke risk factors in Malawian adults. Methods: We performed a case-control study of 222 adults with acute stroke, confirmed by MRI in 86%, and 503 population controls, frequency-matched for age, sex, and place of residence, using Global Positioning System for random selection. Multivariate logistic regression models were used for case-control comparisons. Results: HIV infection (population attributable fraction [PAF] 15%) and hypertension (PAF 46%) were strongly linked to stroke. HIV was the predominant risk factor for young stroke (≤45 years), with a prevalence of 67% and an adjusted odds ratio (aOR) (95% confidence interval) of 5.57 (2.43–12.8) (PAF 42%). There was an increased risk of a stroke in patients with untreated HIV infection (aOR 4.48 [2.44–8.24], p < 0.001), but the highest risk was in the first 6 months after starting antiretroviral therapy (ART) (aOR 15.6 [4.21–46.6], p < 0.001); this group had a lower median CD4+ T-lymphocyte count (92 vs 375 cells/mm3, p = 0.004). In older participants (HIV prevalence 17%), HIV was associated with stroke, but with a lower PAF than hypertension (5% vs 68%). There was no interaction between HIV and hypertension on stroke risk. Conclusions: In a population with high HIV prevalence, where stroke incidence is increasing, we have shown that HIV is an important risk factor. Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk. Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms.

Item Type: Article
Uncontrolled Keywords: Humans, HIV Infections, Hypertension, Anti-HIV Agents, Risk Factors, Case-Control Studies, Adult, Aged, Middle Aged, Malawi, Female, Male, Stroke, Immune Reconstitution Inflammatory Syndrome
Depositing User: Symplectic Admin
Date Deposited: 16 May 2016 13:49
Last Modified: 19 Jan 2023 07:36
DOI: 10.1212/WNL.0000000000002278
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3001235
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