HIV Infection and 90-Day Stroke Outcomes in Uganda: A Prospective Observational Cohort Study.

Autor:	Mbonde AA; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Chang J; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Musubire AK; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Okello S; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Kayanja A; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Moses A; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Butterfield RJ; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Chow FC; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Saylor DR; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., O'Carroll CB; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston., Siedner M; Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston.
Jazyk:	angličtina
Zdroj:	Neurology. Clinical practice [Neurol Clin Pract] 2023 Dec; Vol. 13 (6), pp. e200198. Date of Electronic Publication: 2023 Nov 06.
DOI:	10.1212/CPJ.0000000000200198
Abstrakt:	Background and Objectives: Little is known about the impact of HIV infection on the clinical presentation and outcomes after stroke in the modern antiretroviral therapy (ART) era. We aimed to compare stroke characteristics and outcomes between persons with HIV (PWH) and without HIV (PWOH) presenting with stroke in Uganda. Methods: We conducted a matched cohort study at Mulago National Referral Hospital and Mbarara Regional Referral Hospital between January 2018 and November 2020. We enrolled consecutive PWH presenting with CT-confirmed acute or subacute stroke (symptom onset ≤14 days) and matched them by sex and stroke type to 2 consecutive available PWOH admitted to the same hospital. We obtained baseline clinical data and followed participants for 90 days from the day of clinical presentation. We compared stroke severity (defined by the NIH stroke scale [NIHSS]) and 90-day all-cause mortality and morbidity (using the modified Rankin Scale [mRS]) by HIV serostatus with and without adjustment for confounders. Results: We enrolled 105 PWH and 157 PWOH with stroke. PWH were younger (mean [SD] age 49 [14] vs 59 [16] years, p < 0.001), and nearly 80% (82/105) were on ART for a median of 5 years and a median CD4 count of 214 cells/uL (interquartile range 140, 337). Compared with PWOH, PWH presented with a 3-point lower median NIHSS (16 vs 19, p = 0.011), a 20% lower proportion of all-cause mortality at 90 days ( p = 0.001), and had less disability at 90 days (median mRS 4 vs 5, p = 0.004). Age and NIHSS-adjusted odds ratio of 90-day all-cause mortality in PWH compared with PWOH was 0.45 (95% CI 0.22-0.96, p = 0.037). Discussion: In the modern ART era, PWH with acute stroke in Uganda present with modest stroke and are significantly less likely to die within 90 days than PWOH. This potentially reflects the protective effects of ART, enhanced health care access, and their younger age at stroke presentation. Competing Interests: The authors report no relevant disclosures. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp. TAKE-HOME POINTS → In the antiretroviral therapy era, people with HIV presenting with stroke in Uganda now tend to be on antiretroviral therapy for many years, although persistently low CD4 counts are common in this population.→ People without HIV present with more severe strokes than people with HIV in Uganda, as evidenced by a higher median NIH Stroke Scale score.→ Stroke outcomes are poor overall with a mortality rate at 90 days of 40% in the entire cohort.→ Compared with people with HIV infection, those without HIV infection have higher all-cause mortality and greater disability 90 days after stroke. (© 2023 American Academy of Neurology.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu