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



Benjamin, Laura A ORCID: 0000-0002-9685-1664, Allain, Theresa J, Mzinganjira, Henry, Connor, Myles D, Smith, Colin, Lucas, Sebastian, Joekes, Elizabeth, Kampondeni, Sam, Chetcuti, Karen, Turnbull, Ian
et al (show 5 more authors) (2017) The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke. JOURNAL OF INFECTIOUS DISEASES, 216 (5). pp. 545-553.

[img] Text
JID resubmission_accepted.pdf - Author Accepted Manuscript

Download (1MB)

Abstract

<h4>Background</h4>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.<h4>Methods</h4>We conducted a prospective, in-depth analysis of adult ischemic stroke patients presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, in 2011.<h4>Results</h4>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).<h4>Conclusions</h4>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
Uncontrolled Keywords: stroke, vasculopathy, HIV, Africa, immune reconstitution syndrome
Depositing User: Symplectic Admin
Date Deposited: 21 Feb 2018 12:21
Last Modified: 19 Jan 2023 06:39
DOI: 10.1093/infdis/jix340
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3018280