Lack of impact of HIV status on carotid intima media thickness in a cohort of stroke patients in South Africa

Introduction: People living with HIV (PLWH) are at increased risk for cardiovascular disease. Carotid intima media thickness (cIMT) is a validated surrogate marker of atherosclerosis, and an accurate predictor of future cardiovascular events. It is uncertain whether HIV potentiates stroke risk through atherosclerosis in Sub-Saharan Africa and what effect HIV status has on cIMT. We sought to investigate the relationship between HIV status and cIMT in stroke patients in a region that is burdened with dual epidemics of HIV and stroke in the young. Methods: Consecutive patients with new onset ischaemic stroke were recruited from a quaternary-level hospital in Johannesburg, South Africa, from August 2014 to November 2017. Patients were assessed for the presence of traditional cardiovascular risk factors and HIV infection, and investigated for stroke aetiology. cIMT was measured using high resolution B-mode ultrasound following standardized techniques. Results: 168 patients were included in the study, of which 62 (36.9%) were PLWH. Mean cIMT was higher in HIVuninfected patients when compared to PLWH (0.79 f 0.19 mm vs 0.69 f 0.18 mm, p = 0.0021). However after adjusting for age, sex, hypertension, diabetes mellitus, smoking, total cholesterol, body mass index and stroke aetiology, there was no difference in mean cIMT between the groups (0.76 f 0.16 mm vs 0.73 f 0.17 mm, p = 0.29). Regression models revealed the determinants of cIMT to be age (p < 0.0001), hypertension (p = 0.0098) and total cholesterol (p = 0.005), while the determinants of increased cIMT (>= 0.70 mm) were only age (p < 0.0001) and hypertension (p = 0.0002). Conclusion: HIV status had no effect on cIMT in our cohort of stroke patients. The main determinants of cIMT were age and hypertension.