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Objective: To compare risk factors and clinical outcomes between people with HIV (PWH) and HIV-uninfected (HIVÀ) adults with stroke hospitalized in Zambia. Methods:We retrospectively reviewed charts of all adults admitted to the University Teaching Hospital in Lusaka, Zambia with a clinical diagnosis of stroke between October 2018 and March 2019. Standardized data collection instruments were used to collect demographic, clinical, laboratory and imaging results. Comparison between individuals with and without HIV infection was made using t tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous nonparametric variables, and chi-square analyses for categorical variables.Results: Two hundred and seventy-two adults with stroke were admitted of whom 58 (21%) were PWH. Compared with HIVÀ participants, PWH were younger [(48 AE 14) years versus 62 AE 18) years, P < 0.001]. PWH were less likely to have hypertension (65 versus 83%, P ¼ 0.003) and more likely to have no traditional cerebrovascular risk factors (34 versus 15%, P ¼ 0.01). Deep vein thrombosis (DVT) (4 versus 1%, P ¼ 0.04) was more common during hospitalization amongst PWH but there was no difference in in-hospital mortality (21 versus 23%, P ¼ 0.65). Among PWH with stroke, factors associated with in-hospital mortality were Glasgow Coma Scale (GCS) on admission (7 versus 10, P ¼ 0.046), hypertension (92 versus 59%, P ¼ 0.04) and fever (58 versus 13%, P ¼ 0.003). Conclusion:This Zambian cohort of PWH and stroke is notable for being significantly younger with fewer traditional stroke risk factors but higher rates of DVT than their HIVuninfected counterparts. GCS on admission, hypertension and fever were associated with in-hospital mortality.

Introduction:Preventing complications of stroke such as post-stroke aspiration pneumonia (PSAP) may improve stroke outcomes in resource-limited settings. We investigated the incidence and associated mortality of PSAP in Zambia.Methods:We conducted a prospective cohort study of adults with stroke at University Teaching Hospital (Lusaka, Zambia) between 12/2019-3/2020. NIH Stroke Scale, Glasgow Coma Scale, Modified Rankin Scale scores, and nine indicators of possible PSAP were collected serially over each participant’s admission. PSAP was defined as ≥4 indicators present, and possible PSAP as 2-3 present. T-tests and chi-square tests were used to compare clinical parameters across PSAP groups. Logistic regression was used to assess the relative effects of age, sex, PSAP status, and initial stroke severity on inpatient mortality.Results:We enrolled 125 participants. Mean age was 60±16 years, 61% were female, 55% of strokes were ischemic, and baseline NIH Stroke Scale was 19.7±8.7. Thirty-eight (30%) had PSAP, and 32 (26%) had possible PSAP. PSAP was associated with older age and more adverse stroke severity scores. Fifty-nine percent of participants with PSAP died, compared to 39% with possible PSAP and 8% with no PSAP. PSAP status independently predicted inpatient mortality after controlling for age, sex, and initial stroke severity. Swallow screening was not performed for any participant.Conclusion:PSAP is common and life-threatening in Zambia, especially among older participants with severe stroke presentations. PSAP was associated with significantly increased mortality independent of initial stroke severity, suggesting that interventions to mitigate PSAP may improve stroke outcomes in Zambia and other resource-limited settings.