Headache burden in a HIV population of sub-Saharan Africa: scope and implications from a pilot study
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Headache burden in a HIV population of sub-Saharan Africa: scope and implications from a pilot study Luca Giani 1 & Monica Mwazangati 2 & Derya Uluduz 3 & Tayyar Şaşmaz 4 & Maureen Kamponda 2 & Victor Tamba Tolno 2 & Giovanni Guidotti 5 & Maria Cristina Marazzi 5 & Timothy Steiner 6 & Massimo Leone 1,5
# Fondazione Società Italiana di Neurologia 2020
Recent population-based surveys in sub-Saharan Africa (SSA) have found primary headache disorders to be at least as prevalent as in high-income western countries [1]: in Ethiopia, for example, the 1-year prevalence of migraine was 17.7–22.9%, of tension-type headache (TTH) 20.6– 22.8%, of all headache on ≥ 15 days/month 3.2–11.5%, and of probable medication-overuse headache (pMOH) 0.7–7.1%. Headache-attributed burden was similar to that in western countries. In SSA, while HIV/AIDS affects about 26 million people, improved access to antiretroviral treatments (ART) has contributed much to increased life expectancy in HIV+ patients. Long-term persistence of HIV in the central nervous system (CNS) of millions of HIV+ patients has nonetheless produced a new biological landscape still to be fully understood. HIV is a risk factor for several neurological disorders, to some extent irrespective of the viral load. They include stroke and epilepsy, both having associations with headache. Studies investigating headache in the HIV+ population are called for, but scarce. The aim of this pilot study was to make a first estimate of headache prevalence and burdens attributable to headache in a HIV+ population in a SSA country in order to establish whether further enquiry was needed.
* Massimo Leone [email protected] 1
Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
2
DREAM Program, Blantyre, Malawi
3
Cerrahpaşa School of Medicine, Istanbul, Turkey
4
Mersin University School of Medicine, Mersin, Turkey
5
DREAM Program, Rome, Italy
6
Lifting The Burden: the Global Campaign against Headache, London, UK
The study was performed in Malawi, a SSA country with 18.5 million population, 83% living in rural areas and 77% younger than 45 years. Malawi has very few neurologists: doctors are 0.02 per 1,000 inhabitants (the European mean is 4 per 1,000). and medical activities are usually performed by nonmedical health workers. HIV/AIDS is prevalent but, with increased access to ART (from 3.1 in 2005 to 84% in 2019), HIV prevalence has fallen from 13 to 9.2%, and life expectancy among the general population has increased by 13 years from 2000 to 2016. The study was conducted in collaboration with the DREAM (Disease Relief through Excellent and Advanced Means) program, active in 12 SSA countries (since 2005 in Malawi) to provide health care for HIV/AIDS and noncommunicable diseases (NCDs) [2]. HIV/AIDS centres form a very important part of the primary health-care system in SSA, and the worrying increase in the double burden of HIV/AIDS and NCDs has led United Nations to propose unifying their management at HIV/AIDS
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