Arterial ischemic stroke in HIV

Abstract

HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.

Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable

“…The etiology of cerebrovascular disease in HIV is likely related to a combination of traditional vascular risk factors and HIV-specific factors. HIV infection has been associated with greater adventitial inflammation of large brain arteries and dolichoectasia, compared to HIV-negative controls (Gutierrez et al 2016), and in a recent review (Benjamin et al 2016), several types of HIV-associated vas-culopathies were defined. Given this, it is possible that an increasing burden of cerebrovascular disease in the aging HIV population is one explanation why motor abnormalities still accompany cognitive dysfunction, even when the most severe form (i.e., HAD) is in decline.…”

Evolving concepts of stroke and stroke management in South Africa: Quo vadis?

“…In SA, stroke is responsible for ~25 000 deaths annually and 95 000 years lived with disability. [11] In 2000, stroke was the third most common cause of death in SA, after HIV/AIDS and coronary artery disease. [12] Black women had the highest mortality rate from stroke (160 per 100 000), while mortality was lowest in white men (72 per 100 000).…”

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

“…With the introduction of ART, ischemic stroke has become the more common subtype of stroke identified in PLWH [52, 53, 64]. Some mechanisms that are thought to contribute to the higher prevalence of ischemic stroke in PLWH include: HIV-associated vasculopathy (20–32% prevalence) [60, 61], coagulopathy (19–49%) [60, 61, 65], opportunistic infection (13–28%) [61, 65], and cardioembolism (5–15%) [61, 65].…”

“…For example, Benjamin et al (2016) developed a diagnostic algorithm for stroke that was designed to give greater weight to etiologies that are well-established and/or have treatment implications [64]. In addition to the work up for routine causes of stroke, this algorithm includes diagnostic steps to evaluate specific causes of stroke-like symptoms in HIV-infected individuals, such as co-infections and HIV-associated vasculopathy.…”