Stroke in Sierra Leone. The stroke risk factors for people with HIV: A prospective case-control study

TY - JOUR

T1 - Stroke in Sierra Leone. The stroke risk factors for people with HIV

T2 - A prospective case-control study

AU - Baldeh, Mamadu

AU - Youkee, Daniel

AU - Lakoh, Sulaiman

AU - Rudd, Anthony

AU - Langhorne, Peter

AU - Deen, Gibrilla F

AU - Conteh, Zainab F

AU - Lisk, Durodami R

AU - O'Hara, Jessica

AU - Thompson, Melvina

AU - Brima, Michael Tanu

AU - Wang, Yanzhong

AU - Wolfe, Charles DA

AU - Sackley, Catherine M

N1 - Funding Information: Grant support: National Institute for Health Research (NIHR) (GHR: 17:63:66) / NIHR Programmes Grants for Applied Research Scheme / NIHR Global Health Research Group on Digital Diagnostics for African Health Systems. NIHR134694 / Fogarty International Center (FIC) - ACHIEVE training program, 1D43TW012275-01 / Medical Research Council Clinical Research Training Fellowship: MR/W000903/1.This research was funded by the National Institute for Health Research (NIHR) (GHR: 17:63:66) and supported by the NIHR Programmes Grants for Applied Research Scheme. Views of this publication are not necessarily of the NIHR or the UK Department of Health and Social Care but those of the authors. MB is funded by the Fogarty International Center (FIC) - ACHIEVE training program, 1D43TW012275-01 and NIHR Global Health Research Group on Digital Diagnostics for African Health Systems, NIHR134694 and DY is funded by a Medical Research Council Clinical Research Training Fellowship: MR/W000903/1. Funding Information: This research was funded by the National Institute for Health Research (NIHR) ( GHR: 17:63:66 ) and supported by the NIHR Programmes Grants for Applied Research Scheme. Views of this publication are not necessarily of the NIHR or the UK Department of Health and Social Care but those of the authors. MB is funded by the Fogarty International Center (FIC) - ACHIEVE training program, 1D43TW012275-01 and NIHR Global Health Research Group on Digital Diagnostics for African Health Systems , NIHR134694 and DY is funded by a Medical Research Council Clinical Research Training Fellowship : MR/W000903/1 . Publisher Copyright: © 2023 The Author(s)

PY - 2023/8/4

Y1 - 2023/8/4

N2 - Background: HIV infection rates are relatively low in Sierra Leone and in West Africa but the contribution of HIV to the risk factors for stroke and outcomes is unknown. In this study, we examined stroke types, presentation, risk factors and outcome in HIV stroke patients compared with controls. Methods: We used data from the Stroke in Sierra Leone Study at 2 tertiary hospitals in Freetown, Sierra Leone. A case control design was used to compare stroke type, presentation, risk factors and outcome in sero-positive HIV patients with HIV negative stroke controls. Controls were matched for age and gender and a 1:4 ratio cases to controls was used to optimize power. Analysis was performed using the Pearson x 2 for categorical variable, Paired-T test and Mann-Whitney U test for continuous variables. A p-value of less than 0.05 was taken as the level of statistical significance. Results: Of 511 (51.8%) stroke patients tested for HIV, 36 (7.1%) were positive. Univariate unmatched analysis showed a stroke mean age of 49 years in HIV-positive versus 58 years in HIV-negative population (p = <0.001). In the case-control group, ischaemic stroke is the major type reported in both populations, HIV-negative population: 77 (53.5%) versus HIV-positive: 25 (69.4%) (p = 0.084). Hypertension is the most prevalent risk factor in both groups, HIV-positive: 23 (63.9%) versus HIV-negative: 409 (86.1%) (p = 0.001). Lower CD4+ count is associated in-hospital mortality (p = <0.001). Conclusion: These findings support the current call for timely management of stroke and HIV through integrated care.

AB - Background: HIV infection rates are relatively low in Sierra Leone and in West Africa but the contribution of HIV to the risk factors for stroke and outcomes is unknown. In this study, we examined stroke types, presentation, risk factors and outcome in HIV stroke patients compared with controls. Methods: We used data from the Stroke in Sierra Leone Study at 2 tertiary hospitals in Freetown, Sierra Leone. A case control design was used to compare stroke type, presentation, risk factors and outcome in sero-positive HIV patients with HIV negative stroke controls. Controls were matched for age and gender and a 1:4 ratio cases to controls was used to optimize power. Analysis was performed using the Pearson x 2 for categorical variable, Paired-T test and Mann-Whitney U test for continuous variables. A p-value of less than 0.05 was taken as the level of statistical significance. Results: Of 511 (51.8%) stroke patients tested for HIV, 36 (7.1%) were positive. Univariate unmatched analysis showed a stroke mean age of 49 years in HIV-positive versus 58 years in HIV-negative population (p = <0.001). In the case-control group, ischaemic stroke is the major type reported in both populations, HIV-negative population: 77 (53.5%) versus HIV-positive: 25 (69.4%) (p = 0.084). Hypertension is the most prevalent risk factor in both groups, HIV-positive: 23 (63.9%) versus HIV-negative: 409 (86.1%) (p = 0.001). Lower CD4+ count is associated in-hospital mortality (p = <0.001). Conclusion: These findings support the current call for timely management of stroke and HIV through integrated care.

KW - Stroke

KW - Sierra Leone

KW - Sub – Saharan Africa

KW - HIV

KW - NIHSS

KW - Barthel index

KW - Outcome

UR - http://www.scopus.com/inward/record.url?scp=85166672902&partnerID=8YFLogxK

U2 - 10.1016/j.jstrokecerebrovasdis.2023.107279

DO - 10.1016/j.jstrokecerebrovasdis.2023.107279

M3 - Article

SN - 1052-3057

VL - 32

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

IS - 9

M1 - 107279

ER -