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. 2012;7(3):e33765.
doi: 10.1371/journal.pone.0033765. Epub 2012 Mar 29.

Stroke outcomes in Malawi, a country with high prevalence of HIV: a prospective follow-up study

Terttu Heikinheimo  1 , Daniel Chimbayo, Johnstone J Kumwenda, Sam Kampondeni, Theresa J Allain
Affiliations

Stroke outcomes in Malawi, a country with high prevalence of HIV: a prospective follow-up study

Terttu Heikinheimo et al. PLoS One. 2012.

Abstract

Background: Stroke contributes significantly to disability and mortality in developing countries yet little is known about the determinants of stroke outcomes in such countries. 12% of Malawian adults have HIV/AIDS. It is not known whether having HIV-infection alters the outcome of stroke. The aim of this study was to document the functional outcome and mortality at 1 year of first-ever acute stroke in Malawi. Also to find out if the baseline variables, including HIV-infection, affect the outcome of stroke.

Methods and findings: 147 adult patients with first-ever acute stroke were prospectively followed up for 12 months. Conventional risk factors and HIV-infection were assessed at baseline. Stroke severity was evaluated with modified National Institute of Health Stroke Scale (mNIHSS) and functional outcome with modified Rankin scale (mRS). Fifty (34%) of patients were HIV-seropositive. 53.4% of patients had a poor outcome (severe disability or death, mRS 4-6) at 1 year. Poor outcome was related to stroke severity and female gender but not to presence of HIV-infection. HIV-seropositive patients were younger and had less often common risk factors for stroke. They suffer more often ischemic stroke than HIV-seronegative patients.

Conclusions: Mild stroke and male gender were associated with favourable outcome. HIV-infection is common in stroke patients in Malawi but does not worsen the outcome of stroke. However, it may be a risk factor for ischemic stroke for young people, who do not have the common stroke risk factors. Our results are significant, because stroke outcome in HIV-seropositive patients has not been studied before in a setting such as ours, with very limited resources and a high prevalence of HIV.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Map of Malawi in Africa.
(source: http://www.un.org/depts/Cartographic/map/profile/malawi.pdf).
Figure 2
Figure 2. Study flow chart with CT/MRI-scan findings and outcome.
pt/s = patient/s, WHO = world health organisation, CT/MRI = Computed tomography or magnetic resonance imaging, mRS = modified Rankin scale.
See this image and copyright information in PMC

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