Simply put, stroke is a condition that occurs when a blood vessel in the brain suddenly breaks or is blocked resulting in interruption of, reduced or loss of blood flow to the brain which leads to death of brain cells and symptoms lasting for more than 24 hours or leading to one’s death.
Most of the stroke cases in Africa have been attributed to hypertension, but in Malawi, there is a good percentage of individuals with strokes which are young, and have a low prevalence of established risk factors such as hypertension, suggesting other risk factors of strokes in this young population. In a study conducted by Rensburg et al (2018) of 21 HIV- positive stroke patients and 120 HIV-negative stroke patients, it was found that the mean age of stroke onset for HIV-positive patients and HIV-negative patients was 39.6 years and 54.9 years, respectively. There exists strong evidence that HIV predisposes to stroke. The virus may cause stroke directly for example, through HIV-associated diseases affecting blood vessels (vasculopathy) or indirectly through infections that occur more often or more severe in people with weakened immunity (opportunistic infections) such as tuberculosis and fungal meningitis. In addition, some drugs used in antiretroviral therapy (ART) for HIV are associated with conditions that occur together and increase one’s risks of diabetes, stroke and heart diseases (metabolic syndromes). In a study conducted by Benjamin et al., (2016) it was found that HIV-positive individuals who had recently started antiretroviral therapy (ART) had an especially high risk of stroke, which the researchers attribute to worsening of a known condition or the appearance of new condition after initiating on ART in HIV- positive patients (Immune Reconstitution Inflammatory Syndrome -IRIS).
Young people diagnosed with HIV and Aids, on ART, stroke only adds to the extensive burden of care to such individuals. Rehabilitation management forms a huge part of patients care post stroke. Rensburg et all (2018) reported that ‘patients who sustain a stroke, are HIV-positive, are receiving antiretroviral therapy and rehabilitation may recover similar to those who are HIV-negative, spending a similar length of stay in a rehabilitation clinic. Therefore, stroke survivors who are HIV-positive should receive full rehabilitation similar to any other stroke survivors’.
Physiotherapists form part of the rehabilitation team and should teach and train guardians on proper feeding positions, frequent turning of every two hours to avoid pressure sores and also early mobilisation to ensure that the patient is able to return to the pre-stroke state. Stroke manifests in a number of ways, as such, some of these survivors might have cognitive impairments which might affect their ability to remember to take or continue with attendance of their scheduled ART clinics.
Commonly, stroke patients suffer from cognitive impairments that directly affects their ability to read, write, speak and understand what others are saying (aphasia). More emphasis should be placed on guardians to make sure that the patients continue with their ART treatment.
In general, individuals with HIV and Aids have increased risks of stroke and so require maximum education on how they can reduce other factors that could predispose them to have stroke, aside HIV and Aids. Stopping smoking, eating health foods and maintaining good weight can reduce the risks of strokes occurring in individuals with HIV and Aids.