The prevalence of HIV among patients admitted with stroke at the Muhimbili National Hospital, Dar es Salaam, Tanzania

Abstract

Stroke and HIV infection are both common medical problems in the day to day clinical practice. Although data from developed countries confirm HIV infection as a risk for stroke the exact underlying mechanism is still unclear. Little data exist on the magnitude of HIV among patients with stroke in Tanzania. This cross-sectional study was carried out to determine the prevalence of HIV and assess its impact on the clinical presentation and outcome of patients admitted with stroke at the Muhimbili National Hospital, Dar es Salaam, Tanzania between May and November 2008. Patients were clinically evaluated through history and physical examination. Presence of HIV was determined by demonstration of HIV antibodies through an ELISA test. CD4+ T-lymphocyte count was determined by flowcytometry. Complete blood counts, as well as lipid profile and blood glucose levels were also determined. A total of 215 patients with stroke, constituting 6.8% of the admissions, were analyzed. The prevalence of HIV among patients with stroke was 20.9% (45/215). The overall mean (±SD) age of patients with stroke who were HIV infected was 47.2 (± 14.5) years, while that among patients with stroke but HIV un-infected was 56.1 (±15.1) years (P< 0.001). The proportion of patients with stroke and HIV who had hypertension was 53.3% (24/45), whereas among those HIV uninfected was 80.6% (137/170) (P=<0.001). Furthermore, fever, anaemia, diarrhoea, tuberculosis and Kaposi’s sarcoma were significantly more prevalent among those with HIV than those with no HIV infection. The respective proportions were 44% vs 24.7%; 26.7% vs 7.6%; 20.0% vs 2.9%; 13.3% vs 1.2%; and 6.7% vs 0% (P<0.01). Majority (58.3%) of the HIV infected stroke patients had CD4 counts of less than 200cells/ μl. The mean duration of hospital stay of 10.3 days was significantly longer among those with HIV compared to that of 7.3 days among the HIV un-infected patients with stroke (P=0.001). While on univariate analysis both fever and anaemia were associated with mortality, on multivariate analysis the presence of fever was found to be significantly associated with mortality among patients with stroke and HIV. In conclusion, the prevalence of HIV infection among patients with stroke was high. Patients with stroke and HIV were younger, had significant immunodeficiency and presented with other HIV-related illnesses. Early detection of HIV through enhanced counselling and testing is recommended.