The association of antiretroviral therapy type and duration of use with stroke in people living with HIV in Zambia.

Abstract

Background: People living with HIV (PLWH) are at increased risk of stroke due to many factors including possibly antiretroviral therapy (ART) use. We sought to evaluate the association between ART type and duration of use with stroke in PLWH.

Methods: We conducted a prospective exploratory case-control study at the University Teaching Hospital in Lusaka, Zambia between March 2022 and October 2024 in adult (≥ 18 years) PLWH comparing those with stroke (cases) and without (controls) matched (1:2) for age, sex and race. Standardized data collection instruments were used to collect clinical, laboratory and imaging information. This information was compared between the cases and controls using Chi-square, t-tests, Mann-Whitney U-test (not normally distributed) and multivariable conditional logistic regression analyses with subgroup analysis by ART duration done for the cases.

Results: We analyzed results for 205 cases and 410 controls. Compared to controls, cases were more likely to have hypertension (71% vs. 18%, p = 0.001), lower CD4 counts [293(163-592) cells/µl vs. 533 (376-688) cells/µl, p = 0.0001] and to be on second line ART (23% vs. 4%, p = 0.001). Hypertension (aOR 19.7, 95% CI 3.1-126.4, p = 0.002) and Tenofovir Disoproxil Fumarate (TDF) use (aOR 85.3, 95% CI 5.3-1380.7, p = 0.002) were associated with increased odds of stroke, whereas Dolutegravir (aOR 0.03, 95% CI 0.001-0.58, p = 0.02) and alcohol use (aOR 0.24, 95% CI 0.06-0.95) were associated with reduced odds of stroke. The majority of stroke patients on long-term ART were using Dolutegravir (80% vs. 35%, p = 0.001) and TDF (72% vs. 42%, p = 0.01).

Conclusion: In PLWH, TDF associates with higher odds of stroke. Although Dolutegravir associates with reduced odds of stroke, stroke patients on long-term ART are more likely to be on it.