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Neurol Neuroimmunol Neuroinflamm. 2016 Jun 30;3(4):e254. doi: 10.1212/NXI.0000000000000254. eCollection 2016 Aug.

Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies.

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Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK.


HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.

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