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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 HIV-uninfected patients when compared to PLWH (0.79 ± 0.19 mm vs 0.69 ± 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 ± 0.16 mm vs 0.73 ± 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., Competing Interests: Declaration of competing interest None, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Stroke in people living with HIV (PLWH) has been described to occur soon after the initiation of antiretroviral therapy (ART) possibly related to the Immune Reconstitution Inflammatory Syndrome (IRIS). We sought to investigate whether there was a temporal association between stroke and recent ART initiation in the absence of opportunistic infections (OIs), and to identify risk factors for this., Methods: This cross-sectional study recruited PLWH with new-onset stroke at a hospital in Johannesburg, South Africa, from 2014 to 2017, excluding all patients with OIs. Patients were assessed for ART duration, CD4 count, HIV viral load, inflammatory markers and cardiovascular risk factors., Results: 77 PLWH were recruited, of which 35 were on ART at the time of stroke. Of the patients with confirmed ART duration (n = 28), 9 (32.1%) had a stroke within the first 6 months of starting ART (crude incidence rate of 0.73 cases per patient year). In the period beyond 6 months, 19 strokes occurred (crude incidence rate of 0.21 cases per patient year), translating to a 3.5 times greater risk in the first 6 months (p = 0.0002). There were no clearly identified risk factors when comparing those who had strokes in the first 6 months to those after 6 months and ART-naïve patients., Conclusion: Almost a third of strokes in PLWH may be related to IRIS, with a crude incidence rate 3.5 times higher in the first 6 months following ART-initiation compared to beyond 6 months. This appears to be independent of OIs. Risk factors are unclear., Competing Interests: Declaration of competing interest None, (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: In this brief report, we describe the nature of ALS in a South African cohort of patients of Black African ancestry - a population which has been historically understudied., Methods: We performed a chart review of all patients attending the ALS/MND clinic at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, South Africa, during the period 1 January 2015 to 30 June 2020. Cross-sectional demographic and clinical data captured at the time of diagnosis was collected., Results: Seventy-one patients were included in the study. Males constituted 66% (n = 47), with a male to female sex ratio of 2:1. The median age at onset of symptoms was 46 years (IQR 40-57) with a median disease duration at diagnosis (diagnostic delay) of 2 years (IQR 1-3). The onset was spinal in 76% and bulbar in 23%. The median ALSFRS-R score at time of presentation was 29 (IQR 23-38.5). The median ALSFRS-R slope (unit/month) was 0.80 (IQR 0.43-1.39). Sixty five patients (92%) were diagnosed with the classic ALS phenotype. Fourteen patients were known to be HIV positive, and of those, 12 were on antiretroviral treatment (ART). None of the patients had familial ALS., Conclusion: Our findings of an earlier age at symptom onset and seemingly advanced disease at presentation in patients with Black African ancestry support the existing literature on the African population., Competing Interests: Declaration of Competing Interest None of the authors have any conflict of interest to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: To describe patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) in Johannesburg, South Africa, a setting of high HIV prevalence, and to determine the influence, if any, of HIV on CIDP., Methods: Patients were recruited prospectively. The study design was a hospital based case series of unselected consecutive CIDP patients. CIDP was diagnosed according to the European Federation of Neurological Societies/Peripheral Nerve Society criteria for the diagnosis of CIDP (First Revision). Demographic, clinical, laboratory and electrophysiological data were documented., Results: Twenty three patients with CIDP were recruited over a two year period. Mean age was 38 years. The female to male ratio was 3.6:1. Less than half (43%) had a raised cerebrospinal fluid (CSF) protein. All patients had idiopathic CIDP, three had associated diabetes mellitus. Ten patients (43%) were HIV positive. Thirteen patients were HIV negative. Clinical and electrophysiological characteristics were identical in the two groups. In the HIV positive group all the patients were black females. The CD4 counts ranged from 87 to 747 cells/mm(3). HIV positive status was associated with a progressive disease course and significantly with a CSF lymphocytic pleocytosis (p=0.007). Albuminocytological dissociation was associated with HIV negative status., Conclusions: Testing for HIV in patients with CIDP in a region of high HIV prevalence is recommended. CSF lymphocytic pleocytosis occurs in HIV associated CIDP., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Aim: To determine the frequency and spectrum of neurological illnesses in Black South African hospital-based HIV infected (clade C) patients., Method: A prospective audit of 506 consecutive HIV infected medical inpatients at the Helen Joseph Hospital, Johannesburg, South Africa., Results: The patients had a mean age of 37 years; a male:female ratio of 1.2:1; a mean CD4 count of 107 cells/ml. Eighty four percent of patients had AIDS defining CD4 counts (less than 200 cells/ml). Seventy five percent of patients had a neurological illness. In 64% the neurological illness occurred in association with a non-neurological (systemic) illness. Eleven percent of patients had an isolated neurological illness. The predominant systemic illness was tuberculosis (TB), occurring with a frequency of 46%. The neurological spectrum in our patients was similar to that described in the literature, (clade B virus data) other than for a greater frequency of infectious illnesses., Conclusion: The neurological profile of HIV infection is a function of the environment and the immunological state of the patient (CD4 count) rather than an influence of the clade.

Fifteen HIV-infected patients who presented with new onset seizures (NOS) as the sole neurological manifestation, in whom no cause for the seizure was identifiable, were studied. The patients were mainly female with an average age of 31.3 years. They had generalised new onset seizures with a latency of 1.6 months between the discovery of the HIV positivity and the onset of the seizure. The neurological examinations were normal with no dementia. The electroencephalographic examinations were either normal or there was a generalised epileptic disturbance (GED). The patients have AIDS defining CD4+ T lymphocyte cell counts. There was a high prevalence of pulmonary tuberculosis (PTB) or multiple non-neurological illnesses in our study group. They have normal cerebrospinal fluid (CSF) analysis except for the presence of the HIV virus. All the patients have normal computerised tomogram (CT)/magnetic resonance imaging (MRI) scans of the brain. All the patients studied have abnormal right or left temporal lobe perfusion defects on the SPECT scan studies of the brain. The findings suggest that the new onset seizures in the HIV-infected patients are associated with direct HIV infection. The SPECT scan findings suggest that the HIV virus induce a focal metabolic abnormality or encephalopathy. The new onset seizure is then the manifestation of this abnormality., (Copyright 2002 Elsevier Science B.V.)