The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke.


Benjamin, LA; Allain, TJ; Mzinganjira, H; Connor, MD; Smith, C; Lucas, S; Joekes, E; Kampondeni, S; Chetcuti, K; Turnbull, I; Hopkins, M; Kamiza, S; Corbett, EL; Heyderman, RS; Solomon, T; (2017) The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke. The Journal of infectious diseases, 216 (5). pp. 545-553. ISSN 0022-1899 DOI: https://doi.org/10.1093/infdis/jix340

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Abstract

Human immunodeficiency virus (HIV) infection is a recognized risk factor for stroke among young populations, but the exact mechanisms are poorly understood. We studied the clinical, radiologic, and histologic features of HIV-related ischemic stroke to gain insight into the disease mechanisms. We conducted a prospective, in-depth analysis of adult ischemic stroke patients presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, in 2011. We recruited 64 HIV-infected and 107 HIV-uninfected patients. Those with HIV were significantly younger (P < .001) and less likely to have established vascular risk factors. Patients with HIV were more likely to have large artery disease (21% vs 10%; P < .001). The commonest etiology was HIV-associated vasculopathy (24 [38%]), followed by opportunistic infections (16 [25%]). Sixteen of 64 (25%) had a stroke soon after starting antiretroviral therapy (ART), suggesting an immune reconstitution-like syndrome. In this group, CD4+ T-lymphocyte count was low, despite a significantly lower HIV viral load in those recently started on treatment (P < .001). HIV-associated vasculopathy and opportunistic infections are common causes of HIV-related ischemic stroke. Furthermore, subtypes of HIV-associated vasculopathy may manifest as a result of an immune reconstitution-like syndrome after starting ART. A better understanding of this mechanism may point toward new treatments.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
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PubMed ID: 28931222
Web of Science ID: 410532400007
URI: http://researchonline.lshtm.ac.uk/id/eprint/4433708

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