Stroke in people living with HIV and 6-month outcomes in Northwestern Tanzania

Abstract

Introduction: Stroke in HIV presents with distinct characteristics and varying post-stroke recovery patterns, particularly in the antiretroviral therapy (ART) era. We aimed to evaluate the current trends, characteristics, and 6-month outcomes among people living with HIV (PLWH) compared to people without HIV (PWOH). Methods: This prospective cohort study included adults with stroke registered in the Lake Zone Stroke Registry at Bugando Medical Center between November 2023 and March 2025. Baseline characteristics, stroke severity, and outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS), respectively. The Kaplan-Meier analysis was used to describe survival, and the Cox regression model to determine predictors of mortality. Results: We analyzed 295 adults, with an HIV proportion of 8.8% (95% CI: 5.9%-12.7%) (26/295). The median age for the overall study cohort was 66 years (IQR 53.0-77.0), and 55.9% (165/295) were males. Among PLWH, the median age was 53.5 years (IQR 44.3-67.0), females were 61.5% (16/26), and the majority had hypertension, 57.6% (15/26). The median CD4 count was 518 cells/μl (IQR 151.5-571), and 84.6% (22/26) were naïve to ART. PLWH experienced a longer hospital stay, 5 IQR (2-7) days. Both groups experienced unfavorable functional outcomes (mRS 3-6), 84.7% (250/295), and a mortality rate of 38.6% (114/295) at 6 months. In the multivariable analysis, dyspnea, presence of leukocytosis, and severe stroke were independent predictors of mortality. Conclusion: Although 6-month outcomes were comparable between both groups, targeted strategies are needed to address healthcare disparities and reduce the additional burden of stroke in PLWH.