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  • br Introduction Stroke is the

    2021-10-15


    Introduction Stroke is the second cause of death worldwide and the first cause of acquired motor disability in adults [1], [2]. In sub-Saharan Africa, stroke is the first cause of admission in neurology departments [3]. In Cameroon, the in-hospital mortality of stroke is estimated at 26.8% [4]. Although stroke is more common in the elderly, 25% of cases occur in young adults and ryanodine is a non-negligible risk factor in this group [5]. HIV/AIDS is a worldwide pandemic with 35.3 million infected persons in 2013 and 1.6 million of death [6]. The prevalence of HIV in Cameroon is estimated at 4.3% [7]. HIV can lead to stroke via several mechanisms: acceleration of atherosclerosis and arteriolosclerosis, opportunistic infections causing cerebral vasculitis, blood coagulopathies with protein C and S deficiency and metabolic disorders induced by antiretroviral therapies (ART) such as dyslipidemia and insulin-resistance [8], [9]. HIV infection causes an immunodeficiency which increases the morbidity and mortality of infected patients. The aim of this study was to compare the outcome of stroke in HIV-infected patients and HIV-uninfected patients at the Douala General Hospital (DGH).
    Patients and Methods
    Ethical Considerations
    Results Six hundred and eight (608) stroke cases were recorded over the study period, of which 40 were HIV-infected, giving a prevalence of 6.6%. The mean age of HIV-infected patients was lower than that of HIV-uninfected patients (51.3±10 years vs 59.6±13 years, P<0.001). Of the 40 HIV positive patients, 23 were previously diagnosed HIV-infected on admission while 17 were newly diagnosed HIV-positive during hospitalization. Nineteen of twenty three (83%) previously diagnosed HIV-positive were on first-line antiretroviral treatment recommended in Cameroon: zidovudine+lamivudine+efavirenz (07), tenofovir+lamivudine+efavirenz (05), zidovudine+lamivudine+nevirapine (04), tenofovir+emtracitabine+efavirenz (01), stavudine+lamivudine+nevirapine (01). The proportion of dyslipidemia in the HIV-infected group was significantly greater than that in the HIV-uninfected group (57.5% vs 8.9%, P<0.001), however, when comparing the means of LDL, HDL and triglycerides, there was no statistically significant difference ryanodine between groups (P>0.05). HIV-infected patients presented more with fever on admission compared to HIV-uninfected patients with significant difference (50% vs 25%, P<0.001). Both groups had two-thirds of patients with ischemic stroke. The mean CD4 count in the HIV-infected group (N=20) was 351±236/mm3 while the mean viral load (N=12) was 9177±15218 copies/ml with a median of 540 copies/ml. Comparisons of clinical data and paraclinical investigations between the HIV-infected and HIV-uninfected stroke patients are shown on Table 1. The causes of hemorrhagic stroke were hypertension (63.6%), arterio-veinous malformation (3.38%), probable cerebral amyloid angiopathy (1.55%) and other malformation (2.09%). The cause could not be determined in 28.45% of cases and there was no difference between HIV-positive and HIV-negative patients (P>0.05). Etiologies of ischemic stroke were atherosclerosis (27.0%), mainly found in HIV-infected patients (P<0.027), cardio-embolism (26.56%), small artery disease (2.98%) and undetermined cause (42.0%) mainly found in HIV-uninfected patients (P<0.003). Tuberculous and cryptococcal meningitis were diagnosed respectively in four and two HIV-positive stroke patients. The mean duration of hospitalization was higher in the HIV-infected group (10.3±8.1 days vs 8.1±6.3 days, P=0.042). Fever of unknown origin was more frequent in HIV-infected stroke patients (17.5% vs 6.9%, P=0.014). Table 2 compares the frequency of complications that occurred in both groups. In-hospital mortality was 25% in both groups with no significant difference. The cumulative total proportions of deaths over six months were 37.5% and 34.5% for the HIV-infected stroke patients and HIV-uninfected patients respectively with no significant difference. At six months post-stroke, the proportions of dependent patients were similar in the two groups (38.5% vs 38.8%, P=0.973). Table 3 compares the functional outcome and prognosis between groups. Comparing the outcome between HIV-positive stroke patients on and without antiretroviral treatment, there was no significant difference with respect to mean length of hospital stay, mortality and functional outcome (P>0.05) (Appendix A).