Department of Neurology, Mayo Clinic Arizona, United States; Department of Medicine, Mbarara University, Uganda.
Department of Medicine, Brigham and Women's Hospital, United States.
J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106449. doi: 10.1016/j.jstrokecerebrovasdis.2022.106449. Epub 2022 Apr 25.
HIV infection is an important stroke risk factor in sub-Saharan Africa. However, data on stroke risk factors in the era of antiretroviral therapy (ART) are sparse. We aimed to determine if stroke risk factors differed by HIV serostatus in Uganda.
We conducted a matched cohort study, enrolling persons living with HIV (PWH) with acute stroke, matched by sex and stroke type to HIV uninfected (HIV-) individuals. We collected data on stroke risk factors and fitted logistic regression models for analysis.
We enrolled 262 participants:105 PWH and 157 HIV-. The median ART duration was 5 years, and the median CD4 cell count was 214 cells/uL. PWH with ischemic stroke had higher odds of hypertriglyceridemia (AOR 1.63; 95% CI 1.04, 2.55, p=0.03), alcohol consumption (AOR 2.84; 95% CI 1.32, 6.14, p=0.008), and depression (AOR 5.64; 95%CI 1.32, 24.02, p=0.02) while HIV- persons with ischemic stroke were more likely to be > 55 years of age (AOR 0.43; 95%CI 0.20-0.95, p=0.037), have an irregular heart rhythm (AOR 0.31; 95%CI 0.10-0.98, p=0.047) and report low fruit consumption (AOR 0.39; 95%CI 0.18-0.83, p=0.014). Among all participants with hemorrhagic stroke (n=78) we found no differences in the prevalence of risk factors between PWH and HIV-.
PWH with ischemic stroke in Uganda present at a younger age, and with a combination of traditional and psychosocial risk factors. By contrast, HIV- persons more commonly present with arrhythmia. A differential approach to stroke prevention might be needed in these populations.
在撒哈拉以南非洲，HIV 感染是中风的一个重要危险因素。然而，在抗逆转录病毒治疗（ART）时代，关于中风危险因素的数据很少。我们旨在确定乌干达的中风危险因素是否因 HIV 血清状态而异。
我们进行了一项匹配队列研究，招募了急性中风的 HIV 感染者（PWH），并按性别和中风类型与 HIV 未感染者（HIV-）相匹配。我们收集了中风危险因素的数据，并拟合了逻辑回归模型进行分析。
我们共纳入了 262 名参与者：105 名 PWH 和 157 名 HIV-。中位数 ART 持续时间为 5 年，中位数 CD4 细胞计数为 214 个/μL。缺血性中风的 PWH 发生高甘油三酯血症的几率更高（比值比 1.63；95%置信区间 1.04，2.55，p=0.03）、饮酒（比值比 2.84；95%置信区间 1.32，6.14，p=0.008）和抑郁（比值比 5.64；95%置信区间 1.32，24.02，p=0.02），而 HIV-的缺血性中风患者更可能年龄大于 55 岁（比值比 0.43；95%置信区间 0.20-0.95，p=0.037）、心律失常（比值比 0.31；95%置信区间 0.10-0.98，p=0.047）和报告水果摄入低（比值比 0.39；95%置信区间 0.18-0.83，p=0.014）。在所有出血性中风患者（n=78）中，我们未发现 PWH 和 HIV-之间中风危险因素的患病率存在差异。
乌干达的 PWH 发生缺血性中风的年龄更小，且存在传统和心理社会危险因素的组合。相比之下，HIV-的患者更常见心律失常。在这些人群中，可能需要采取不同的中风预防方法。
