Division of Neurology, Department of Neurosciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Neurol Sci. 2024 Oct 15;465:123186. doi: 10.1016/j.jns.2024.123186. Epub 2024 Aug 14.
People living with HIV (PLWH) are at increased risk for cardiovascular disease. Carotid intima media thickness (cIMT) is a validated surrogate marker of atherosclerosis, and an accurate predictor of future cardiovascular events. It is uncertain whether HIV potentiates stroke risk through atherosclerosis in Sub-Saharan Africa and what effect HIV status has on cIMT. We sought to investigate the relationship between HIV status and cIMT in stroke patients in a region that is burdened with dual epidemics of HIV and stroke in the young.
Consecutive patients with new onset ischaemic stroke were recruited from a quaternary-level hospital in Johannesburg, South Africa, from August 2014 to November 2017. Patients were assessed for the presence of traditional cardiovascular risk factors and HIV infection, and investigated for stroke aetiology. cIMT was measured using high resolution B-mode ultrasound following standardized techniques.
168 patients were included in the study, of which 62 (36.9%) were PLWH. Mean cIMT was higher in HIV-uninfected patients when compared to PLWH (0.79 ± 0.19 mm vs 0.69 ± 0.18 mm, p = 0.0021). However after adjusting for age, sex, hypertension, diabetes mellitus, smoking, total cholesterol, body mass index and stroke aetiology, there was no difference in mean cIMT between the groups (0.76 ± 0.16 mm vs 0.73 ± 0.17 mm, p = 0.29). Regression models revealed the determinants of cIMT to be age (p < 0.0001), hypertension (p = 0.0098) and total cholesterol (p = 0.005), while the determinants of increased cIMT (≥0.70 mm) were only age (p < 0.0001) and hypertension (p = 0.0002).
HIV status had no effect on cIMT in our cohort of stroke patients. The main determinants of cIMT were age and hypertension.
HIV 感染者（PLWH）患心血管疾病的风险增加。颈动脉内膜中层厚度（cIMT）是动脉粥样硬化的有效替代标志物，也是未来心血管事件的准确预测指标。尚不确定 HIV 是否通过撒哈拉以南非洲的动脉粥样硬化增加中风风险，以及 HIV 状况对 cIMT 有何影响。我们试图在一个同时受到 HIV 和年轻人中风双重流行影响的地区，调查 HIV 状况与中风患者 cIMT 之间的关系。
从 2014 年 8 月至 2017 年 11 月，连续招募来自南非约翰内斯堡四级医院的新发缺血性中风患者。评估患者是否存在传统心血管危险因素和 HIV 感染，并调查中风病因。使用标准技术的高分辨率 B 型超声测量 cIMT。
本研究共纳入 168 例患者，其中 62 例（36.9%）为 PLWH。与未感染 HIV 的患者相比，HIV 未感染者的平均 cIMT 更高（0.79±0.19mm 比 0.69±0.18mm，p=0.0021）。然而，在校正年龄、性别、高血压、糖尿病、吸烟、总胆固醇、体重指数和中风病因后，两组间的平均 cIMT 无差异（0.76±0.16mm 比 0.73±0.17mm，p=0.29）。回归模型显示，cIMT 的决定因素为年龄（p<0.0001）、高血压（p=0.0098）和总胆固醇（p=0.005），而 cIMT 增加（≥0.70mm）的决定因素仅为年龄（p<0.0001）和高血压（p=0.0002）。
在我们的中风患者队列中，HIV 状况对 cIMT 没有影响。cIMT 的主要决定因素是年龄和高血压。
