Stroke in Black South African HIV-Positive Patients

Mochan, Andre; Modi, Mala; Modi, Girish

doi:10.1161/01.str.0000043821.35051.fa

Cited by 87 publications

(102 citation statements)

References 34 publications

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“…Findings of low CD4+ cells among HIV infected stroke patients in this study is consistent with prior evidence that low CD4+T-cell count may increase the risk of stroke in HIV-infected patients (Hsue et al, 2004;Baker et al, 2007), is also similar to low CD4 count found in (77%) black South African HIV positive stroke patients (Mochan et al, 2003). Additionally, observational studies in other developing countries have suggested an association between immune dysfunction and stroke based on increased hospital admissions for young immunosuppressed HIV-positive patients with ischemic stroke in the absence of other obvious risk factors of ischemic stroke.…”

Section: Discussionsupporting

confidence: 91%

“…The frequency (20%) of HIV infection among patients in this study is remarkably similar to the 18% found in a retrospective study among black Africans (Mochan et al, 2003) HIV infection among stroke in this study is remarkably similar to the 18% found in a retrospective study among black Africans 2003) and 15% of all strokes in young infected black Africans in KwaZulu-Natal province (Hoffmann et al, 2000). Therefore, findings of this study supported earlier ones that showed that in most parts of Africa, about 25% of cases of stroke occur in young adults and HIV infection is becoming an important contributor (Imam 2002).…”

Section: Discussionsupporting

confidence: 87%

“…A study among HIV-infected individuals was shown that, a low CD4 T-cell count was independently associated with an increased prevalence of carotid lesions (Robert et al, 2008) which is one of the proposed mechanisms of stroke. In addition, earlier study by Mochan et al (2003), demonstrated association between advanced immunosuppression and opportunistic infections.…”

Section: Discussionmentioning

confidence: 88%

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Immune Dysfunction in HIV infected stroke patients: Role of low CD<sub>4</sub> counts

Watila¹

2015

Nig J Bas App Sci

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Whether or not low CD4 count directly contributes to stroke among HIV infected stroke patients is yet to be elucidated. This study aimed to ascertain the role of low CD4 count in the pathophysiology of stroke in HIV infection. This was a hospital-based, case-control study. Sixty five (65) consecutive stroke patients (36 males and 29 females) aged 20-68 years and sixty five (65) age-and-sex matched controls were enrolled. A structured questionnaire was administered. Neurological examination was performed and computed tomography scan of the brain done. Blood samples were taken for HIV 1&2 screening using ELISA method. Positive test using two different kits constituted a positive result. CD4 count was determined by western blot method. The mean CD4 count of HIV positive stroke patients (224.92 cells/cm 3

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 88%

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Immune Dysfunction in HIV infected stroke patients: Role of low CD<sub>4</sub> counts

Watila¹

2015

Nig J Bas App Sci

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“…Data from studies performed before combination ART are confounded by advanced disease and associated opportunistic infections that may increase ICH risk. 25 Furthermore, ICH was less common than ischemic stroke in many of these studies, 26,27 reflecting the typical breakdown of stroke by subtype and rendering it difficult to draw conclusions based on small numbers of events. Studies evaluating ICH from the current era of combination ART conflict.…”

mentioning

confidence: 99%

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Chow

Bacchetti

et al. 2014

Neurology

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Objective: To compare rates of intracerebral hemorrhage (ICH) in HIV-infected and uninfected individuals in a large clinical care cohort and to assess risk factors associated with ICH. Methods:We identified incident ICH in HIV-infected and uninfected control cohorts from the Partners Health Care system using ICD-9-CM codes. We constructed Cox proportional hazards models to estimate adjusted hazard ratios for HIV infection and other predictors of ICH.Results: The incidence rate of ICH was 2.29 per 1,000 person-years in HIV-infected individuals compared with 1.23 per 1,000 person-years in uninfected individuals, with an unadjusted incidence rate ratio of 1.85 (95% confidence interval 1.37-2.47, p , 0.001). In a multivariable model, HIV infection was independently associated with a higher hazard of ICH, although its effect diminished with increasing age. Female sex was associated with a lower hazard of ICH in the uninfected cohort but not in the HIV cohort. CD4 count ,200 3 10 6 cells/L and anticoagulant use were predictive of ICH.Conclusions: HIV infection conferred an increased adjusted hazard of ICH, which was more pronounced in young patients and in women. Cardiovascular and cerebrovascular event rates are increased in HIV infection. [1][2][3][4][5][6][7] Several studies pointing to an elevated risk of cerebrovascular disease in HIV-infected individuals have focused on ischemic stroke and excluded intracranial hemorrhage. 5,8,9 Whereas ischemic stroke and cardiovascular disease often coexist and share a similar risk profile and underlying mechanism, the association between HIV and intracerebral hemorrhage (ICH), which has mechanisms distinct from ischemic stroke, is less clear. We examined the association of HIV with the risk of ICH by comparing the incidence of ICH in HIV-infected and uninfected individuals in a large US clinical care cohort. Our primary hypothesis was that the rate of ICH in HIV-infected individuals would be higher than in uninfected individuals. We further controlled for potential confounders and identified predictors of ICH in HIV-infected individuals.METHODS Study design and patient population. We conducted an observational study of an HIV cohort derived from the Partners HealthCare System Research Patient Data Registry (RPDR), a clinical care database of all inpatient and outpatient encounters from Massachusetts General Hospital and Brigham and Women's Hospital. Other vascular outcomes have been studied in this cohort.3,5 HIV-infected individuals were identified from the RPDR using ICD-9-CM codes 042 or V08, previously validated in the cohort. 5 The HIV cohort was matched by age, race, and sex in a 1:10 ratio to HIV-uninfected individuals, who constituted the control cohort. The control cohort was intentionally overpopulated to allow for the possibility of missing data and application of the exclusion criteria. Within the cohorts, individuals who were at least 18 years of age at the beginning of the observation period and who had at least 1 inpatient or 2 outpatient clinical encou...

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“…5 Many of these had AIDS-defining illnesses and smoking as contributors to the stroke. A prospective small study 6 of 35 hospital-based patients identified meningitis, cardioembolic sources, and protein S deficiency. Meningitis was excluded from our cohort, protein S was not routinely measured in many of our patients.…”

mentioning

confidence: 99%

Oculogyric dystonic states in early-onset parkinsonism with basal ganglia calcifications

Kis

Hedrich²,

Kann³

et al. 2005

Neurology

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Abstract-Cerebrovascular disease occurs in HIV-positive individuals, but no relationship between the two has been established. The authors reviewed a cohort of patients aged 15 to 44 years to evaluate stroke in HIV-positive and negative subjects. Patients who were HIV-positive with no other identifiable etiology were compared to age-and race-matched HIV-negative patients. HIVpositive and HIV-negative groups did not differ in angiographic, cardiac, or serologic tests. A positive HIV test does not provide causal information or diagnosis. NEUROLOGY 2005;65:759-761

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Stroke in Black South African HIV-Positive Patients

Abstract: The results are similar to data from studies on young black African stroke patients who are HIV negative.

Cited by 87 publications

References 34 publications

Immune Dysfunction in HIV infected stroke patients: Role of low CD<sub>4</sub> counts

Immune Dysfunction in HIV infected stroke patients: Role of low CD<sub>4</sub> counts

Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort

Oculogyric dystonic states in early-onset parkinsonism with basal ganglia calcifications

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