Stroke in Human Immunodeficiency Virus-infected Individuals in Sub-Saharan Africa (SSA): A Systematic Review

Almasi‐Hashiani, Amir; Chang, Jonathan L.; O’Carroll, Cumara B; Musubire, Abdu K; Chow, Felicia C.; Wilson, Anthony L.; Siedner, Mark J.

doi:10.1016/j.jstrokecerebrovasdis.2018.02.016

Cited by 45 publications

(49 citation statements)

References 43 publications

(97 reference statements)

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“…3 Previous studies estimate an incidence of approximately 1% to 6.4% of stroke in children with HIV, although studies following autopsy have shown much higher rates of up to 34%. 16,36,37 In both Malawian and Zambian populations, HIV infection has been associated with stroke in young adults, but most studies of HIV and stroke have not included subjects younger than 18 years. 38,39 HIV is known to cause cerebral vasculopathy, 40 angiitis, 41 aneurysmal dilatation 42 (particularly fusiform aneurysms in children 43 ), arterial stenosis complicated by ischemic infarction, 44 and secondary moyamoya syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…45 Although there is significant literature on HIV-associated cerebrovascular disease, its precise mechanism is not known. 24,36,46 Adult studies have found that stroke is not common in HIV without an additional underlying disease state. 47 These disease states include infections including varicella zoster virus, 42 cryptococcus, 48,49 neurocysticercosis, 50 hepatitis B, 51 syphilis, 52 and tuberculosis, 53 as well as neoplastic and prothrombotic states.…”

Section: Discussionmentioning

confidence: 99%

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Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

Dean

Buda

Adams

et al. 2020

Pediatric Neurology

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Background: Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. Methods: Thirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. Results: We identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P ¼ 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm 3 , P ¼ 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P ¼ 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P ¼ 0.02) of HIV-infected subjects with cognitive impairment. Conclusions: These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

Dean

Buda

Adams

et al. 2020

Pediatric Neurology

View full text Add to dashboard Cite

show abstract

“…In this specific region, stroke was commonly found to be the first manifestation of HIV infections. In a systematic review, over 90% of young adults with stroke in sub-Saharan Africa with HIV were ischaemic strokes and stroke patients with HIV often had a coagulopathy and more severe stroke compared with young adults with stroke without HIV 27. Similarly, these findings may also be found in other developing countries.…”

Section: Epidemiology and Stroke Aetiology From A Global Perspectivementioning

confidence: 91%

“…Other infections are also associated with a high risk of ischaemic stroke, including HIV, neurocysticercosis and tuberculosis. HIV has a high prevalence in sub-Saharan Africa with over two-thirds of the world’s population 27 28. In this specific region, stroke was commonly found to be the first manifestation of HIV infections.…”

Section: Epidemiology and Stroke Aetiology From A Global Perspectivementioning

confidence: 99%

Ischaemic stroke in young adults: a global perspective

Boot¹,

Ekker²,

Putaala

et al. 2020

J Neurol Neurosurg Psychiatry

154

147

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Ischaemic stroke at young age is an increasing problem in both developing and developed countries due to rising incidence, high morbidity and mortality and long-term psychological, physical and social consequences. Compared with stroke in older adults, stroke in young adults is more heterogeneous due to the wide variety of possible underlying risk factors and aetiologies. In this review, we will provide an overview of the global variation in the epidemiology of stroke in young adults, with special attention to differences in geography, ethnicity/race and sex, as well as traditional and novel risk factors for early-onset ischaemic stroke, such as air pollution. Understanding global differences is an important prerequisite for better region-specific prevention and treatment of this devastating condition.

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“…There have been numerous mechanisms proposed to explain this. A systematic review done by Addallah et al 37 reported that this could be due to HIV-associated opportunistic infections, HIV-induced coagulopathy, and chronic inflammatory processes that can accelerate atherosclerosis. Another systematic review by Bogorodskaya et al 38 also reported that some antiretrovirals (lopinavir, indinavir, and abacavir) were also associated with an increased risk of stroke.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Thalamomesencephalic stroke due to vasculitis in a patient with HIV

et al. 2020

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We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. A computed tomography (CT) angiogram confirmed a diffuse vasculitis with parenchymal changes in the right thalamus and midbrain. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory. This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.

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Stroke in Human Immunodeficiency Virus-infected Individuals in Sub-Saharan Africa (SSA): A Systematic Review

Cited by 45 publications

References 43 publications

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

Brain Magnetic Resonance Imaging Findings Associated With Cognitive Impairment in Children and Adolescents With Human Immunodeficiency Virus in Zambia

Ischaemic stroke in young adults: a global perspective

Case Report: Thalamomesencephalic stroke due to vasculitis in a patient with HIV

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