Recent Developments regarding Human Immunodeficiency Virus Infection and Stroke

Abstract

Human immunodeficiency virus (HIV) infection is strongly associated with ischemic stroke in the young. Data obtained from the Nationwide Inpatient Sample in the United States show an increase in the number of stroke hospitalizations in the HIV-infected population despite an overall decrease in the number of stroke hospitalizations. Few data exist, however, that address the mechanism of HIV-associated stroke. Recent studies have demonstrated that HIV may infect the endothelium and alter cerebrovascular functions. Whether the proposed mechanism alters the stroke risk is undetermined. Epidemiological studies suggest that HIV-related stroke is associated with a risk factor profile that differs from the HIV-negative young stroke population in that HIV-associated strokes are less likely to have hypertension, diabetes, hyperlipidemia and smoking as risk factors. A large population-based study, moreover, suggests an association between antiretroviral therapy and increased cardio- and cerebrovascular risks. Specific antiretroviral agents such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors have been implicated in the metabolic syndrome, accelerated atherosclerosis and an increased risk for ischemic stroke. In addition to discussing these developments, this paper also discusses the implications of recent data for stroke prevention in HIV-infected patients.

Cardiac involvement in HIV-positive patients

“…In HIV-positive patients, the exact mechanisms whereby smoking increases the risk of cardiovascular events are yet to be determined, 21 but endothelial damage appears to be the cornerstone of heart disease in HIV 22 and it has become apparent that the effect of smoking can augment the damage produced by the virus itself, the immune response of the host, 23 or by potential toxicity of older drugs used in the treatment of HIV infection. 24 Furthermore, recent studies have shown that the population-attributable risk of death associated with smoking is higher (61.5%) among HIV-positive patients compared to controls (34.2%), postulating that in this particular category or patients, more life-years are lost to smoking than to HIV.…”

Acute Ischemic Stroke in Young Immunocompromised Patient With Hypolipidemia

“…Acceleration of large vessel atherosclerosis, endothelial injury and dyslipidemia can be caused by antiretroviral therapy [10]. FABP4 (fatty acid binding protein-4) is a strong plasma marker of metabolic disturbances in HIV-infected patients, and therefore, could serve to guide therapeutic intervention in this group of patients [11].…”

Intracranial vascular complications in AIDS

“…Таким образом, патогенез ВИЧ-ассоциированной церебральной васкулопатии является многофактор-ным: вирусная инвазия стенки сосуда, эндотели-альное повреждение ВИЧ-протеинами, хроническая иммунная дисфункция и воспаление стенки сосудов, токсичность АРВТ, инфекционный (Varicella zoster) церебральный васкулит [22,32,[42][43][44][45].…”