Factors associated with incidence of stroke and heart failure among people living with HIV in Ghana: Evaluating Vascular Event Risk while on Long-Term Antiretroviral Suppressive Therapy (EVERLAST) Study

Risk of Stroke Among HIV Patients: A Systematic Review and Meta-analysis of Global Studies and Associated Comorbidities

BACKGROUND

Despite advancements in the management of HIV infection, the factors contributing to stroke development among HIV-positive individuals remain unclear. This systematic review and meta-analysis aim to identify and evaluate the relative risk factors associated with stroke susceptibility in the HIV population.

METHODS

A comprehensive search was conducted in PubMed, Scopus, and Web of Science databases to identify studies investigating the risk of stroke development in HIV patients and assessing the role of different risk factors, including hypertension, diabetes, dyslipidemia, smoking, sex, and race. The quality assessment of case-control studies was conducted using the Newcastle-Ottawa Scale, whereas cohort studies were assessed using the National Institute of Health tool. Meta-analyses were performed using a random-effects model to determine pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

A total of 18 observational studies involving 116,184 HIV-positive and 3,184,245 HIV-negative patients were included. HIV-positive patients exhibited a significantly higher risk of stroke compared with HIV-negative patients [OR (95% CI): 1.31 (1.20 to 1.44)]. Subgroup analyses revealed increased risks for both ischemic stroke [OR (95% CI): 1.32 (1.19 to 1.46)] and hemorrhagic stroke [OR (95% CI): 1.31 (1.09 to 1.56)]. Pooled adjusted HRs showed a significant association between stroke and HIV positivity (HR: 1.37, 95% CI: 1.22 to 1.54). Among HIV-positive patients with stroke, hypertension [OR (95% CI): 3.5 (1.42 to 8.65)], diabetes [OR (95% CI): 5 (2.12 to 11.95)], hyperlipidemia, smoking, male gender, and black race were associated with an increased risk.

DISCUSSION

Our study revealed a significant increased risk of stroke development among people with HIV. A multitude of factors, encompassing sociodemographic characteristics, racial background, underlying health conditions, and personal behaviors, significantly elevate the risk of stroke in individuals living with HIV. The use of observational studies introduces inherent limitations, and further investigations are necessary to explore the underlying mechanisms of stroke in people with HIV for potential treatment strategies.

CONCLUSION

HIV patients face a higher risk of stroke development, either ischemic and hemorrhagic strokes. Hypertension, diabetes, hyperlipidemia, smoking, male gender, and black race were identified as significant risk factors. Early identification and management of these risk factors are crucial in reducing stroke incidence among patients living with HIV.

Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis

Background

The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana.

Methods

We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model.

Result

Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66).

Conclusion

The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors.

Prevalence and incidence of stroke among people with HIV

OBJECTIVE

We aimed to obtain more precise estimates of stroke to address the wide variation of stroke burden among people with HIV (PWH) in different clinical settings.

DESIGN

Systematic review and meta-analysis.

METHODS

We systematically searched PubMed, EMBASE, and Web of Science for original articles reporting the prevalence and incidence of stroke among PWH up to November 23, 2022. Der Simonian-Laird random effects were used to obtain pooled estimates and 95% confidence intervals (CIs).

RESULTS

We included 17 observational studies covering 1 749 003 PWH on estimation of prevalence, and 17 cohort studies covering 249 606 PWH on estimation of incidence. The pooled prevalence of stroke was 1.30% (95% CI: 1.01%, 1.59%) for PWH aged at least 15 years, and 3.98% (95% CI: 2.45%, 5.51%) for PWH aged at least 50 years. The pooled incidence of stroke was 17.86 per 10 000 person-years (95% CI: 15.96, 19.76), meanwhile, the pooled incidence of ischemic stroke (31.50 per 10 000 person-years; 95% CI: 11.11, 51.89) was higher than hemorrhagic stroke (4.43 per 10 000 person-years; 95% CI: 1.95, 6.91) among PWH aged at least 15 years.

CONCLUSION

The prevalence of stroke was nearly one per hundred among PWH aged ≥15 years, and reached four per hundred for those aged ≥50 years. The occurrence of stroke is common during HIV progression, particularly ischemic stroke. Therefore, more efforts should be made on implementing policies, strategies, and programs aimed at identifying the risk factors, improving treatment, and facilitating rehabilitation for stroke to reduce the disease burden among PWH.

Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021

PURPOSE OF THE REVIEW

To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding.

RECENT FINDINGS

In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.