Abdallah Amir, Chang Jonathan L, O'Carroll Cumara B, Musubire Abdu, Chow Felicia C, Wilson Anthony L, Siedner Mark J
Department of Medicine, Mbarara University of Science and Technology, Uganda.
Duke University School of Medicine, Durham, North Carolina.
J Stroke Cerebrovasc Dis. 2018 Jul;27(7):1828-1836. doi: 10.1016/j.jstrokecerebrovasdis.2018.02.016. Epub 2018 Apr 5.
Human immunodeficiency virus (HIV) infection is associated with worse outcomes after stroke, but this association is less well-described in sub-Saharan Africa (SSA). We reviewed literature on stroke among people living with HIV (PLWH) in SSA.
We systematically reviewed published literature for original clinical stroke studies conducted in SSA that included PLWH. We included studies that reported data on presenting characteristics, risk factors, and/or outcomes after stroke.
Seventeen studies (N = 478) met inclusion criteria. At the time of stroke presentation, PLWH had a median age ranging from 32 to 43 years. Subjects had low CD4 counts (median CD4, 108-225 cells/µl), and most were antiretroviral therapy-naïve. Fever, seizures, and concurrent opportunistic infections were common at presentation. Ischemic stroke accounted for up to 96% of strokes, which were mostly located in the anterior circulation territory. In studies comparing PLWH with HIV-uninfected individuals, PLWH had more frequent coagulopathy, greater stroke severity, (72% versus 36% National Institutes of Health Stroke Scale >13, P = .02), longer hospital length of stay (30.5 versus <10 days), and a higher 30-day mortality rate (23% versus 10.5%, P = .007).
Stroke in PLWH in SSA occurs at a young age, in those with advanced disease, and is associated with worse outcomes than in HIV-uninfected comparators. Stroke in young individuals in the region should prompt HIV testing, and ongoing efforts to promote early antiretroviral therapy initiation might also help decrease stroke incidence, morbidity, and mortality in the region.
人类免疫缺陷病毒（HIV）感染与中风后更差的预后相关，但在撒哈拉以南非洲（SSA），这种关联的描述较少。我们回顾了SSA地区HIV感染者（PLWH）中风的相关文献。
我们系统回顾了在SSA地区进行的、纳入了PLWH的已发表的原始临床中风研究。我们纳入了报告中风后临床表现特征、危险因素和/或预后数据的研究。
17项研究（N = 478）符合纳入标准。中风发作时，PLWH的中位年龄在32至43岁之间。受试者的CD4计数较低（中位CD4，108 - 225个细胞/微升），且大多数未接受过抗逆转录病毒治疗。发热、癫痫发作和并发机会性感染在发病时很常见。缺血性中风占中风的比例高达96%，主要位于前循环区域。在将PLWH与未感染HIV的个体进行比较的研究中，PLWH的凝血障碍更常见，中风严重程度更高（美国国立卫生研究院中风量表>13分的比例为72%对36%，P = 0.02），住院时间更长（30.5天对<10天），30天死亡率更高（23%对10.5%，P = 0.007）。
SSA地区PLWH的中风发生在年轻、疾病晚期的人群中，且与未感染HIV的对照者相比，预后更差。该地区年轻人中风应促使进行HIV检测，持续努力促进早期抗逆转录病毒治疗的启动也可能有助于降低该地区中风的发病率、发病率和死亡率。
