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Stroke Outcomes in Malawi, a Country with High Prevalence of HIV: A Prospective Follow-Up Study 1,2 2 2 3 Terttu Heikinheimo *, Daniel Chimbayo , Johnstone J. Kumwenda , Sam Kampondeni , Theresa J. Allain2 1 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland, 2 Department of Medicine, College of Medicine, Blantyre, Malawi, 3 Department of Radiology, College of Medicine, Blantyre, Malawi Abstract Background: Stroke contributes significantly to disability and mortality in developing countries yet little is known about the determinants of stroke outcomes in such countries. 12% of Malawian adults have HIV/AIDS. It is not known whether having HIV- infection alters the outcome of stroke. The aim of this study was to document the functional outcome and mortality at 1 year of first-ever acute stroke in Malawi. Also to find out if the baseline variables, including HIV-infection, affect the outcome of stroke. Methods and Findings: 147 adult patients with first-ever acute stroke were prospectively followed up for 12 months. Conventional risk factors and HIV-infection were assessed at baseline. Stroke severity was evaluated with modified National Institute of Health Stroke Scale (mNIHSS) and functional outcome with modified Rankin scale (mRS). Fifty (34%) of patients were HIV-seropositive. 53.4% of patients had a poor outcome (severe disability or death, mRS 4–6) at 1 year. Poor outcome was related to stroke severity and female gender but not to presence of HIV-infection. HIV-seropositive patients were younger and had less often common risk factors for stroke. They suffer more often ischemic stroke than HIV-seronegative patients. Conclusions: Mild stroke and male gender were associated with fav