To determine whether risk factors for ischemic and hemorrhagic stroke differ by HIV serostatus 

The incidence of stroke is rising in sub-Saharan Africa (SSA), and HIV infection is thought to be a key risk factor.  However, data on stroke risk factors in the era of antiretroviral therapy (ART) are sparse.

We conducted a matched cohort study in two tertiary hospitals in Uganda. We enrolled persons living with HIV (PWH) presenting with acute stroke and matched them by sex and stroke type to HIV uninfected (HIV-) individuals. We collected data on stroke risk factors and fitted logistic regression models to assess if risk factors for ischemic and hemorrhagic stroke differ by HIV serostatus

We enrolled 262 participants:105 PWH and 157 HIV-. The median duration on ART was 5 years, and the median CD4 cell count was 214 cells/uL. Among all participants with ischemic stroke (n=184), hypertension (53%), psychosocial stress (65%), elevated LDL (51%) and diabetes (22%) were common. PWH with ischemic stroke were more likely to have hypertriglyceridemia (AOR 1.63; 95% CI 1.04, 2.55, p=0.03), report alcohol consumption (AOR 2.84; 95%CI 1.32, 6.14, p=0.008), and depression (AOR 5.64; 95%CI 1.32, 24.02, p=0.02) whilst HIV- persons were more likely to be aged > 55 years (AOR 0.43; 95%CI 0.20-0.95, p=0.037), have an irregular pulse rhythm (AOR 0.31; 95%CI 0.10-0.98, p=0.047) and report low fruit consumption (AOR 0.39; 95%CI 0.18-0.83, p=0.014). Among all participants with hemorrhagic stroke (n=78), hypertension (58%) and psychosocial stress (74%) were common, but we found no differences in the prevalence of risk factors between PWH and HIV-.

PWH with ischemic stroke in Uganda present at a younger age, and with a combination of traditional and psychosocial risk factors. By contrast, HIV- persons more commonly present with arrhythmia. A differential approach to stroke prevention might be needed in these populations.