The Association of Hypercoagulability state markers in adult HIV positive patients with Ischaemic stroke at The University Teaching Hospital, Lusaka, Zambia

Abstract

INTRODUCTION: There has been a substantial and significant increase in patients hospitalized for ischaemic stroke with co-existing HIV infection. Little is known about the mechanism of stroke in these HIV+ve patients as no studies had been done in our region. Elsewhere, attributed mechanisms included vasculitis and hypercoagulability state with protein S deficiency being a prominent feature. Little is also known of the effect of antiretroviral drugs on patients with hypercoagulability state. Hence there is a need for this study to help understand the role of hypercoagulability state in HIV+ve ischaemic stroke patients and consequently help improve their management. METHODOLOGY A matched case control study was conducted in which a total of 52 HIV+ve patients with ischaemic stroke were prospectively compared with control groups for occurrence of protein S, protein C deficiencies, hyperhomocysteinaemia as well as other markers like hypercholesterolaemia and obesity. The control groups comprised an equal number of consecutive matched HIV-ve and HIV+ve patients with and without ischaemic stroke respectively. RESULTS Ischaemic stroke of undetermined aetiology occurred more frequently in HIV+ve compared to HIV-ve patients (p<0.001). In addition, protein S deficiency and Hyperhomocysteinaemia were more prominent in HIV+ve than HIV-ve ischaemic stroke patients (P=0.011). There was no difference in the presence of hyperhomocysteinaemia or protein S deficiency in HIV+ve patients with or without ischaemic stroke. Protein C deficiency was not noted to be significantly different between the cases and the two control arms. CONCLUSION There was a strong association between hypercoagulability state and ischaemic stroke in adult HIV+ve patients with traditional markers like smoking, sedentary lifestyle and obesity noted. Protein S deficiency and hyperhomocysteinaemia are strongly associated with HIV infection, and their presence in HIV+ve ischaemic stroke warrants them to be considered as important serum markers in the prevention of ischaemic strokes in the Zambian HIV+ve population.