The Association of Premature Atherosclerosis with Ischemic Stroke in Young People with HIV in Lusaka, Zambia.

Background: Premature atherosclerosis has been observed among people with HIV (PWH) with high risk of cerebrovascular disease. The aim of this study was to evaluate premature atherosclerosis in young PWH with and without ischemic stroke.

Methods: We conducted a prospective case-control study at the University Teaching Hospital in Lusaka, Zambia between March 2022 and October 2024, comparing young PWH with non-cardioembolic ischemic stroke (cases) with PWH without a history of stroke (controls) matched (1:2) for age, sex and race. Premature atherosclerosis was assessed using a Mindray DC-40, linear probe 8-13MHz high resolution B-mode ultrasound to measure carotid intima-media thickness (cIMT; abnormal≥0.70mm) and pulse wave velocity (PWV; abnormal≥10.00m/s).

Results: We analyzed results for 50 cases and 100 controls. Compared to controls, cases were more likely to have traditional stroke risk factors such as hypertension (42% vs. 1%, p=0.001); shorter duration from HIV diagnosis (<3 months: 16% vs. 1%, p=0.001);and markers of atherosclerotic disease, including higher PWV [10.89 (9.99-12.15) m/s vs. 8.97 (8.16 - 9.54) m/s, p<0.001] and increased cIMT [0.79 (0.70-0.99) mm vs. 0.63 (0.58 - 0.67) mm, p<0.001]. Poor WHO HIV clinical stage (stage 3: aOR 58, 95% CI 1-3213, p=0.04), higher PWV (aOR 8.7, 95% CI 2.0-38.1, p=0.004) and urban residence (aOR 25.5, 95% CI 1.6-413.4, p=0.02) were independently associated with ischemic stroke in multivariable analyses.

Conclusion: In this cohort of young-onset HIV-associated non-cardioembolic ischemic stroke, premature atherosclerosis, as indicated by higher PWV, was independently associated with stroke.