Evidence map›Paper›PMID 26683649›Full record

ArticleNeurology2016

HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: A case-control study.

Laura A Benjamin, Elizabeth L Corbett, Myles D Connor, Henry Mzinganjira, Sam Kampondeni, Augustine Choko, Mark Hopkins, Hedley C A Emsley, Alan Bryer, Brian Faragher and 3 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 98 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
98citing papers in PubMed, 8 pooled it
11.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

98 citing papers in PubMed, 8 syntheses or guidelines pooled it, 154 citations in OpenAlex.

  1. Pooled it
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  6. Stroke in Human Immunodeficiency Virus-infected Individuals in Sub-Saharan Africa (SSA): A Systematic Review.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2018
    Pooled it
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  12. Integrating neurology in community healthcare in sub-Saharan Africa: experience and outcomes of the 7-year partnership between the Italian Society of Neurology and the DREAM program.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Review
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  16. The association of premature atherosclerosis with ischemic stroke in young people with HIV in Lusaka, Zambia.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025
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38 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 7 institutions in 2 countries.

Laura A BenjaminFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK. l.benjamin@liverpool.ac.uk.
Elizabeth L CorbettFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Myles D ConnorFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Henry MzinganjiraFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Sam KampondeniFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Augustine ChokoFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Mark HopkinsFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Hedley C A EmsleyFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Alan BryerFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Brian FaragherFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Robert S HeydermanFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Theresa J AllainFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
Tom SolomonFrom the Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., A.C., R.S.H.) and the Department of Medicine (L.A.B., H.M., S.K., R.S.H., T.J.A.), College of Medicine, University of Malawi, Blantyre; the Brain Infections Group (L.A.B., T.S.), Institute of Infection and Global Health, University of Liverpool (L.A.B., H.C.A.E., T.S.); the Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool; the Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine; the NHS Borders and Division of Clinical Neuroscience (M.D.C.), University of Edinburgh, UK; the School of Public Health (M.D.C.), University of the Witwatersrand, Johannesburg, South Africa; the Royal Liverpool Hospital (M.H.); the Royal Preston Hospital (H.C.A.E.), Liverpool, UK; the Department of Medicine (A.B.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; the Liverpool School of Tropical Medicine (B.F.); the Division of Infection and Immunity (R.S.H.), University College London; and the National Institute for Health Research (T.S.), Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
University of Malawi · MWWalton Centre · GBLiverpool School of Tropical Medicine · GBNational Institute for Health Research · GBMalawi-Liverpool-Wellcome Trust Clinical Research Programme · MWUniversity College London · GBUniversity of Liverpool · GB

Funding

Department of Health IS-HPU-1112-10117Wellcome Trust
6 · The paper itself

Abstract

objectiveTo investigate HIV, its treatment, and hypertension as stroke risk factors in Malawian adults.

methodsWe performed a case-control study of 222 adults with acute stroke, confirmed by MRI in 86%, and 503 population controls, frequency-matched for age, sex, and place of residence, using Global Positioning System for random selection. Multivariate logistic regression models were used for case-control comparisons.

resultsHIV infection (population attributable fraction [PAF] 15%) and hypertension (PAF 46%) were strongly linked to stroke. HIV was the predominant risk factor for young stroke (≤45 years), with a prevalence of 67% and an adjusted odds ratio (aOR) (95% confidence interval) of 5.57 (2.43-12.8) (PAF 42%). There was an increased risk of a stroke in patients with untreated HIV infection (aOR 4.48 [2.44-8.24], p < 0.001), but the highest risk was in the first 6 months after starting antiretroviral therapy (ART) (aOR 15.6 [4.21-46.6], p < 0.001); this group had a lower median CD4(+) T-lymphocyte count (92 vs 375 cells/mm(3), p = 0.004). In older participants (HIV prevalence 17%), HIV was associated with stroke, but with a lower PAF than hypertension (5% vs 68%). There was no interaction between HIV and hypertension on stroke risk.

conclusionsIn a population with high HIV prevalence, where stroke incidence is increasing, we have shown that HIV is an important risk factor. Early ART use in immunosuppressed patients poses an additional and potentially treatable stroke risk. Immune reconstitution inflammatory syndrome may be contributing to the disease mechanisms.

Indexed as

AdultAgedAnti-HIV AgentsCase-Control StudiesFemaleHIV InfectionsHumansHypertensionImmune Reconstitution Inflammatory SyndromeMalawiMaleMiddle AgedRisk FactorsStrokeAnti-HIV Agents

Identifiers

PMID26683649
PMCPMC4776088
OpenAlexW2209195511

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.