PMID- 38219384
OWN - NLM
STAT- MEDLINE
DCOM- 20240219
LR  - 20240219
IS  - 1878-5883 (Electronic)
IS  - 0022-510X (Linking)
VI  - 457
DP  - 2024 Feb 15
TI  - Stroke, HIV and the Immune Reconstitution Inflammatory Syndrome in the absence of 
      opportunistic infections.
PG  - 122880
LID - S0022-510X(24)00015-7 [pii]
LID - 10.1016/j.jns.2024.122880 [doi]
AB  - INTRODUCTION: Stroke in people living with HIV (PLWH) has been described to occur 
      soon after the initiation of antiretroviral therapy (ART) possibly related to the 
      Immune Reconstitution Inflammatory Syndrome (IRIS). We sought to investigate 
      whether there was a temporal association between stroke and recent ART initiation 
      in the absence of opportunistic infections (OIs), and to identify risk factors 
      for this. METHODS: This cross-sectional study recruited PLWH with new-onset 
      stroke at a hospital in Johannesburg, South Africa, from 2014 to 2017, excluding 
      all patients with OIs. Patients were assessed for ART duration, CD4 count, HIV 
      viral load, inflammatory markers and cardiovascular risk factors. RESULTS: 77 
      PLWH were recruited, of which 35 were on ART at the time of stroke. Of the 
      patients with confirmed ART duration (n = 28), 9 (32.1%) had a stroke within the 
      first 6 months of starting ART (crude incidence rate of 0.73 cases per patient 
      year). In the period beyond 6 months, 19 strokes occurred (crude incidence rate 
      of 0.21 cases per patient year), translating to a 3.5 times greater risk in the 
      first 6 months (p = 0.0002). There were no clearly identified risk factors when 
      comparing those who had strokes in the first 6 months to those after 6 months and 
      ART-naive patients. CONCLUSION: Almost a third of strokes in PLWH may be related 
      to IRIS, with a crude incidence rate 3.5 times higher in the first 6 months 
      following ART-initiation compared to beyond 6 months. This appears to be 
      independent of OIs. Risk factors are unclear.
CI  - Copyright (c) 2024 The Author(s). Published by Elsevier B.V. All rights reserved.
FAU - Sadiq, Eitzaz
AU  - Sadiq E
AD  - Division of Neurology, Department of Neurosciences, School of Clinical Medicine, 
      Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South 
      Africa. Electronic address: eitzaz.sadiq@wits.ac.za.
FAU - Katzew, Sarah
AU  - Katzew S
AD  - Department of Internal Medicine, School of Clinical Medicine, Faculty of Health 
      Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic 
      address: sarahkatzew@gmail.com.
FAU - Nel, Jeremy
AU  - Nel J
AD  - Department of Internal Medicine, School of Clinical Medicine, Faculty of Health 
      Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic 
      address: Jeremy.nel@wits.ac.za.
FAU - Tade, Grace
AU  - Tade G
AD  - Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, 
      Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South 
      Africa. Electronic address: oluwatosin.tade@wits.ac.za.
FAU - Woodiwiss, Angela
AU  - Woodiwiss A
AD  - Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, 
      Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South 
      Africa. Electronic address: angela.woodiwiss@wits.ac.za.
FAU - Norton, Gavin
AU  - Norton G
AD  - Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, 
      Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South 
      Africa. Electronic address: physiology@health.wits.ac.za.
FAU - Modi, Girish
AU  - Modi G
AD  - Division of Neurology, Department of Neurosciences, School of Clinical Medicine, 
      Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South 
      Africa. Electronic address: girish.modi@wits.ac.za.
LA  - eng
PT  - Journal Article
DEP - 20240108
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
SB  - IM
MH  - Humans
MH  - *Immune Reconstitution Inflammatory Syndrome/epidemiology/etiology
MH  - Cross-Sectional Studies
MH  - South Africa/epidemiology
MH  - *HIV Infections/complications/drug therapy/epidemiology
MH  - *Opportunistic Infections/complications
MH  - *Stroke/epidemiology/complications
MH  - CD4 Lymphocyte Count
OTO - NOTNLM
OT  - Antiretroviral therapy
OT  - HIV
OT  - IRIS
OT  - Immune reconstitution inflammatory syndrome
OT  - South Africa
OT  - Stroke
COIS- Declaration of competing interest None
EDAT- 2024/01/15 00:42
MHDA- 2024/02/19 06:44
CRDT- 2024/01/14 18:06
PHST- 2023/11/30 00:00 [received]
PHST- 2024/01/05 00:00 [revised]
PHST- 2024/01/06 00:00 [accepted]
PHST- 2024/02/19 06:44 [medline]
PHST- 2024/01/15 00:42 [pubmed]
PHST- 2024/01/14 18:06 [entrez]
AID - S0022-510X(24)00015-7 [pii]
AID - 10.1016/j.jns.2024.122880 [doi]
PST - ppublish
SO  - J Neurol Sci. 2024 Feb 15;457:122880. doi: 10.1016/j.jns.2024.122880. Epub 2024 
      Jan 8.