Association between antiretroviral therapy initiation or reinitiation timing and neuroimaging-confirmed stroke in people with HIV

Résumé

Stroke among people with HIV (PWH) has been linked to initiating or reinitiating antiretroviral therapy (ART) within six months.1,2,3 We examined this association in a large prospective cohort. We conducted a descriptive interim analysis of data from the ongoing AVALON study investigating stroke in PWH (NIH-1R21TW012384-01A1). Over 12 months (September 2024–August 2025), we included all PWH presenting with neuroimaging-confirmed acute/subacute stroke (imaging within three weeks of symptom onset) to Western Cape public sector hospitals with brain imaging facilities (n = 10). We identified 605 PWH with stroke. Median age was 44 years (interquartile range [IQR] 36–54), with 51% female at birth (Table 1). Ischaemic stroke comprised 85% of cases, mostly involving the middle cerebral artery territory (63%). Previous stroke (> 4 weeks before current) was evident in 17%. At presentation, 76% were on ART for a median 8.2 years (IQR 3.8–11.9), most commonly tenofovir/lamivudine/dolutegravir (73%). ART was initiated/reinitiated within six months prior to stroke in 24.4%, with a median of 68 days (IQR 26–119) from initiation/reinitiation to stroke. ART adherence derived from pharmacy refills was 57% in the preceding six months. The most recent median viral load was < 50 copies/mL (IQR < 20–6777), measured a median of 85 days (IQR 4–420) before stroke. We report the largest South African cohort of PWH with stroke to date. Participants were young, on currently recommended ART, and 28% had no comorbidities. A quarter initiated/reinitiated ART within six months of stroke, supporting previous reports suggesting a potential immune reconstitution-like syndrome.

Citer ce document

Accès au document

Texte intégral en lecture en ligne, réservé aux abonnés SPHAERO et aux membres de l'institution. Se connecter

Auteur(s)

Statistiques

Consultations : 1

Téléchargements : 0