HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice: review article

Abstract

An established relationship exists between human immunodeficiency virus (HIV) and the vascular system, which is characterised by clinical expressions of aneurysmal and occlusive disease that emanate from a common pathological process. The exact pathogenesis is currently unknown; attempts to implicate opportunistic pathogens have been futile. Theories converge on leucocytoclastic vasculitis with the vaso vasora as the vasculopathic epicentre. It is thought that the virus itself or viral proteins trigger the release of inflammatory mediators that cause endothelial dysfunction and smooth muscle proliferation leading to vascular injury and thrombosis. The beneficial effects of highly active anti-retroviral therapy alter the natural history of the disease profile and promote longevity but are negated by cardiovascular complications. Atherosclerosis is an emerging challenge. Presently patients are managed by standard surgical protocols because of non-existent universal surgical interventional guidelines. Clinical response to treatment is variable and often compounded by complications of graft occlusion, sepsis and poor wound healing. The clinical, imaging and pathological observations position HIV-associated large-vessel vasculopathy as a unique entity. This review highlights the spectrum of HIV-associated large-vessel aneurysmal, occlusive and atherosclerotic disease in vascular surgical practice.

Vulval Tuberculosis: The Histomorphological Spectrum in Patients with HIV Co-Infection and AIDS

“…Despite the heightened recognition of the spectrum of HIV-related infective vasculitic and vasculopathic reactions, the pathogenesis thereof remains enigmatic [59,60]. HIV-induced endothelial dysfunction, vascular wall injury, increased viral load and associated increase in inflammatory cytokines and tumour necrosis factor-α have been proposed [59,60]. Leucocytoclastic and granulomatous vasculitis, manifestations of type III and type IV hypersensitivity reactions [62], respectively, were present in 12 and 1 biopsy each, respectively, in the present study.…”

“…Leucocytoclastic vasculitis may be caused by a range of viral, fungal, bacterial and parasitic diseases. While M.Tb and HIV may cause vascular pathology independently by several mechanisms, the presence of vasculitis in the context of TB and HIV co-infection is poorly reported [54][55][56][57][58][59][60][61][62]. The co-occurrence of TB and vasculitis was first reported in 1967 [55].…”

“…The 3 main presentations of cutaneous vasculitis, described in the context of pulmonary TB, are cutaneous leucocytoclastic vasculitis, Henoch Schonlein purpura and rifampicin-induced vasculitis [55]. Despite the heightened recognition of the spectrum of HIV-related infective vasculitic and vasculopathic reactions, the pathogenesis thereof remains enigmatic [59,60]. HIV-induced endothelial dysfunction, vascular wall injury, increased viral load and associated increase in inflammatory cytokines and tumour necrosis factor-α have been proposed [59,60].…”

Human Immunodeficiency Virus Associated Large Artery Disease

“…Endothelial cell dysfunction as a result of increase in inflammatory mediators to viral proteins has been implicated in the pathogenesis of HIV related vasculitis [5]. The inflammatory mediators include interleukins 1, 6 and 8, and tumour necrosis factor-alpha.…”

“…Patients may present with a diverse array of aneurysms, occlusive disease, spontaneous arteriovenous fistulae and dissections. The precise pathogenesis of HIV related vasculitis remains poorly understood, a few recent studies have tried to address this issue [5].…”