Clinical and radiological characteristics of HIV-associated intracerebral haemorrhage in Malawi.

Background:

Stroke incidence is increasing in sub-Saharan African (SSA), especially due to intracerebral hemorrhage (ICH). We sought to describe the clinical and radiological characteristics of stroke due to ICH in people living with HIV (PLWH) in Malawi.

Methods:

Using a cross-sectional design, we compared the clinical and radiological characteristics of ICH in PLWH and HIV negative patients. We rated ICH location as deep, or lobar, using the Cerebral Haemorrhage Anatomical RaTing inStrument (CHARTS), and radiological features, including periventricular and deep white matter hyperintensities (PVWM and DWM). We compared characteristics using parametric t-tests or non-parametric Mann-Whitney U tests.

Results:

We included 39 participants with ICH (10 PLWH; 29 HIV-negative). The median age was 60 (IQR 48-68); 22 (56%) were female. Among PLWH, the median (IQR) CD4 count was 364 cells/mm3 (164,411) and 7 (70%) were naïve to HIV treatment. Compared with HIV-negative controls, HIV-positive patients were younger (median (IQR) 49.5 years (35, 60) v 62 years (54,69)), and hypertension was common in both groups (PLWH [8,80%] v HIV-negative [26,90%]). PLWH often had lobar haematoma ICH (40% v 0%, p<0.003 and p=0.002 after controlling for age). White matter hyperintensity was prevalent (PVWM 77% v 79%; DWM 60% v 69%) and similar in both groups despite the age disparity.

Conclusions:

In PLWH, we found an association with lobar location ICH-Stroke. Hypertension and cerebral small vessel disease markers were common in both groups, suggesting that better screening and treatment of hypertension could reduce the burden of stroke due to ICH regardless of HIV status.