Lancaster EPrints

HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults

Benjamin, Laura A. and Corbett, Elizabeth L. and Connor, Myles D. and Mzinganjira, Henry and Kampondeni, Sam and Choko, Augustine and Hopkins, Mark and Emsley, Hedley C. A. and Bryer, Alan and Faragher, Brian and Heyderman, Robert S. and Allain, Theresa J. and Solomon, Tom (2016) HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults. Neurology, 86 (4). pp. 324-333. ISSN 0028-3878

Full text not available from this repository.

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/mm 3, 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
Journal or Publication Title: Neurology
Subjects:
Departments: Faculty of Health and Medicine > Medicine
ID Code: 84596
Deposited By: ep_importer_pure
Deposited On: 07 Feb 2017 09:52
Refereed?: Yes
Published?: Published
Last Modified: 16 Dec 2017 06:46
Identification Number:
URI: http://eprints.lancs.ac.uk/id/eprint/84596

Actions (login required)

View Item