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Study Finds African Men With HIV at Greater Risk for Stroke


A study published Dec. 18 in the journal Neurology shows that HIV is the leading risk factor for stroke among young African adults in Malawi.

While many studies have shown that HIV causes a heightened state of inflammation and, as a consequence, cardiovascular problems, this study showed that up to 42 percent of stroke cases among people under 45 could be attributed to HIV infection. The case-controlled study involved 222 stroke patients and 503 controls.

“There was no association with stroke and high blood pressure in young adults, showing that HIV infection is an independent risk factor,” the University of Liverpool reported in a news release.

Across sub-Saharan Africa, stroke is on the rise. “It is postulated that HIV predisposes to stroke,” the authors wrote. “The virus may cause stroke directly (for example, through HIV-associated vasculopathy) or indirectly (through opportunistic infections). In addition, some drugs used in antiretroviral therapy (ART) for HIV are associated with metabolic syndromes, therefore potentially increasing stroke risk with prolonged use.”

But this study showed that people with HIV on their first six months of antiretroviral therapy are at higher risk of stroke.

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“The link between HIV infection and stroke is now more convincing than ever,” Dr. Laura Benjamin, who led the study, said in the news release. “While in the longer term treatment reduces stroke risk, we were surprised to find that the risk actually increases in the first few months of therapy.”

The researchers surmised that the greater stroke risk early in ART treatment could be attributed to increased inflammation during immune reconstitution.

Malawi is the seventh-poorest country in the world with an HIV prevalence rate of 10.3 percent. In the study, first-line therapy for HIV infection was stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). Alternative first-line therapy for zidovudine (AZT), 3TC and NVP.

The researchers reported that d4T toxicity or poor medication adherence could be contributing to stroke factors either independently or in combination with other factors related to beginning ART. “Because our numbers were limited in the early ART cohort, the results should be interpreted with caution,” they wrote.

“While ART is necessary for improved HIV related outcomes overall, the association between early ART use and stroke events poses an additional (and potentially treatable) risk,” the researchers concluded. “How to address this is something that the research community will need to consider in sub-Saharan Africa and beyond.”

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