The complexity of HIV vasculopathy

Stanley, Alan; Candy, Sally; Levin, Candyce; Heckmann, Jeannine M.

doi:10.7196/samj.5470

Cited by 10 publications

(3 citation statements)

References 5 publications

(12 reference statements)

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“…Consistent with this, other research describes pathological changes to resting CBF and functional hyperemia in infected persons, prior to experiencing neurocognitive decline. In addition, there has been a reported increase in both hemorrhagic and ischemic stroke in HIV‐infected people , as well as frequent vascular complications that may contribute to HAND . We recently showed that acute, intracranial exposure of mice to HIV‐1 Tat resulted in decreased CVR in response to hypercapnic challenge .…”

Section: Introductionmentioning

confidence: 99%

Chronic Central Nervous System Expression of HIV‐1 Tat Leads to Accelerated Rarefaction of Neocortical Capillaries and Loss of Red Blood Cell Velocity Heterogeneity

et al. 2014

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Objectives HIV-1 infection of the central nervous system is associated with impairment of cerebral blood flow and neurocognitive function, and accelerated signs of aging. Since normal aging is associated with rarefaction of the cerebral vasculature, we set out to examine chronic viral effects on the cerebral vasculature. Methods Doxycycline-inducible HIV-1 Tat transgenic (Tat-tg) and wild-type (WT) control mice were used. Animals were treated with doxycycline for 3 weeks or 5–7 months. Cerebral vessel density and capillary segment length were determined from quantitative image analyses of sectioned cortical tissue. In addition, movement of red blood cells in individual capillaries was imaged in vivo using multiphoton microscopy, to determine red blood cell velocity and flux. Results Mean RBCV was not different between Tat-tg mice and age matched WT controls. However, cortical capillaries from Tat-tg mice showed a significant loss of RBCV heterogeneity and increased RBCF that was attributed to a marked decrease in total cortical capillary length (35–40%) compared to WT mice. Conclusions Cerebrovascular rarefaction is accelerated in HIV-1 Tat transgenic mice, and this is associated with alterations in red cell blood velocity. These changes may have relevance to the pathogenesis of HIV-associated neurocognitive disorders in an aging HIV positive population.

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Section: Introductionmentioning

confidence: 99%

Chronic Central Nervous System Expression of HIV‐1 Tat Leads to Accelerated Rarefaction of Neocortical Capillaries and Loss of Red Blood Cell Velocity Heterogeneity

et al. 2014

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“…25 Viral infections associated with stroke include HIV (infarcts, vasculitis, aneurysmal vasculopathy), 26 Dengue shock syndrome, 27 West-Nile virus, Japanese encephalitis and VZV. 25 Bacterial infections such as TBM, syphilis, and infective endocarditis can involve large and small cerebral vessels whereas in leptospirosis, a large intracranial arteriopathy has been described.…”

Section: Strokementioning

confidence: 99%

Tropical Neurology

Heckmann¹,

Bhigjee²

2014

Manson's Tropical Infectious Diseases

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“…The intracranial vessels of these children – all with high viral loads and low CD4 counts – were described as tortuous and ectatic, often with aneurysmal dilatations [5, 6]. Case reports of cerebral vasculopathy in HIV-infected adults were subsequently published [7, 8]. Observational studies of stroke in HIV-infected patients again noted the presence of vasculopathy in a subset of patients – intra- and extracranial, including both stenotic and aneurysmal lesions.…”

Section: Introductionmentioning

confidence: 99%

Frequency and Risk Factors for Cerebral Arterial Disease in a HIV/AIDS Neuroimaging Cohort

et al. 2016

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Background: Infection with HIV predisposes patients to a myriad of neurologic disorders, including cerebrovascular disease. The pathophysiology is likely multifactorial, with proposed mechanisms including infectious vasculitis, HIV-induced endothelial dysfunction and adverse effects of combination antiretroviral therapy (cART). Epidemiologic data on clinically evident cerebral vasculopathy in HIV-infected adults is scarce, even though stroke hospitalizations are rising in this patient population. Methods: A total of 6,298 HIV-infected adults (San Francisco General Hospital, 2000-2013) were screened to generate a cohort of patients with dedicated neuroimaging of the intra- and extracranial cerebral vasculature. We extracted information regarding the extent of HIV disease (including serial viral load and CD4 counts), cardiovascular disease risk factors and exposure to cART (cross-referenced with pharmacy records) and performed multivariate logistic regression analysis to identify predictors of vasculopathy. Results: Of 144 patients, 55 patients (38.2%) had radiographic evidence of cerebral vasculopathy. Twenty (13.9%) had a vasculopathy characterized by vessel dolichoectasia and intracranial aneurysm formation. Thirty-five patients (24.3%) had intra- and or extracranial stenosis/occlusion. cART use (OR 2.27, 95% CI 1.03-5) and tobacco abuse (OR 2.35, 95% CI 1.04-5.25) were independently associated with the development of any vasculopathy, whereas cART use was also an independent risk factor for the stenosis/occlusion subtype specifically (OR 2.87, 95% CI 1.11-7.45). Conclusions: There was a high frequency of cerebral arterial disease in this neuroimaging cohort of HIV/AIDS patients. A history of cART use and a history of tobacco abuse were independent risk factors for vasculopathy, though these findings should be confirmed with large-scale prospective studies.

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The complexity of HIV vasculopathy

Cited by 10 publications

References 5 publications

Chronic Central Nervous System Expression of HIV‐1 Tat Leads to Accelerated Rarefaction of Neocortical Capillaries and Loss of Red Blood Cell Velocity Heterogeneity

Chronic Central Nervous System Expression of HIV‐1 Tat Leads to Accelerated Rarefaction of Neocortical Capillaries and Loss of Red Blood Cell Velocity Heterogeneity

Tropical Neurology

Frequency and Risk Factors for Cerebral Arterial Disease in a HIV/AIDS Neuroimaging Cohort

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