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    • br Discussion Considering cardiovascular risk factors

    2022-01-17


    Discussion Considering cardiovascular risk factors, there was a significant difference in prevalence of dyslipidemia in both groups, 57.5% in HIV-infected stroke patients compared to 8.9% in the HIV-uninfected patients. These results are similar to that of Chow et al. who found a dyslipidemia prevalence of 44% in HIV-infected stroke patients compared to 30% in HIV-uninfected patients (P<0.001) [10]. Similar studies by Heikinheimo et al. in Malawi as well as Mlay and Bakari in Tanzania found no difference between the two groups [11], [12]. HIV infection and antiretroviral therapy cause metabolic disorders characterized by dyslipidemia and lipodystrophy with an abdominal redistribution of fatty tissue [13]. Looking at cardiovascular risk factors, there was difference in the prevalence of Tetracaine HCl and other cardiovascular risk factors in both groups. Similar results were reported by Gnonlonfoum et al. in 2013 [14]. However, studies by Mlay and Bakari, and Heikinheimo et al. reported a significant difference between both groups with a significant predominance of hypertension among HIV-uninfected patients (P<0.001 and P<0.0001 respectively) [11], [12]. About 50% of HIV-infected patients had fever on admission compared to 25% of HIV-uninfected stroke patients (P<0.001). This result is similar to that reported by other authors who found fever in 44% of HIV-infected stroke patients as against 24.7% in HIV-uninfected stroke patients (P=0.01) [12]. At admission, there was no significant difference in the blood pressure in both groups of patients. Our result differs from that of Qureshi et al. (1997) who found a significant difference in blood pressure during admission between the two groups with a predominance of hypertension in the HIV-uninfected group (P<0.0001) [15]. While most of our patients were in a confused state upon admission, Gnonlonfoun et al. reported that more than 2/3 of HIV-infected stroke patients were admitted in a severely ill state [14]. In both groups, two-thirds of patients presented with ischemic stroke. These results are similar to those obtained by Gnonlonfoun et al. [14]. Most of our HIV-infected patients were not severely immunodepressed (mean CD4 count=351±236/mm3) when comparing with those of Cotonou in Bénin where a mean CD4 count of 119±36/mm3 was reported [14]. HIV-infected stroke patients had a mean duration of hospitalization significantly greater than that of HIV-uninfected patients (10.3±8.1 days vs 8.1±6.3 days, P=0.042). Our results are similar to those obtained by Mlay and Bakari who found a mean duration of hospitalization in HIV-infected stroke patients of 10.3 days against 7.3 days for HIV-uninfected stroke patients (P<0.001) [12]. Fever of unknown origin was significantly more frequent among the HIV-infected than the HIV-uninfected stroke patients (17.5% vs 6.9%, P=0.014). Gnonlonfoun et al. reported similar results (24% vs 15%, P=0.002). This higher rate of fever of unknown origin in HIV-positive stroke patients may be due to the absence of prophylaxis of major opportunistic parasitic infection by cotrimoxazole which can reduce the frequency of bacterial infection. Also, the lack of specific culture media (blood and urine culture) could explain this. The overall cumulative mortality over six months was 32.3% of the total population (37.5% for HIV-infected stroke patients against 34.5% for HIV-uninfected stroke patients). In-hospital mortality was not different between the two groups. Other authors did not find any significant difference in mortality between HIV-infected stroke patients (28.9%) and HIV-uninfected stroke patients (31.2%) [12]. Death occurred mainly during hospitalization as shown in the Kaplan–Meier survival curve (Fig. 1). The functional outcome post-stroke evaluated with the Rankin score (at M1, M3 and M6) were similar in the two groups with two-thirds of survivals having a good functional outcome (Rankin score<2). Our findings are similar to those obtained by Heikinheimo et al. who did not find any significant difference in functional outcome at 6th week, 6th month and one year post-stroke in the groups of HIV-infected and HIV-uninfected stroke patients using the same scale [11].