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J Infect Dis. 2017 Sep 1;216(5):545-553. doi: 10.1093/infdis/jix340.

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

Author information

1
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre.
2
Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, United Kingdom.
3
Department of Medicine, College of Medicine, University of Malawi, Blantyre.
4
Walton Centre NHS Foundation Trust, Liverpool.
5
NHS Borders, Melrose.
6
Division of Clinical Neurosciences, University of Edinburgh, United Kingdom.
7
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
8
Centre for Clinical Brain Sciences, University of Edinburgh.
9
Department of Histopathology, North Wing, St Thomas' Hospital, London.
10
Department of Radiology, Royal Liverpool University Hospital.
11
Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool.
12
North Manchester General Hospital.
13
Royal Liverpool University Hospital, United Kingdom.
14
Department of Pathology, College of Medicine, University of Malawi, Blantyre.
15
Department of Clinical Research, London School of Hygiene and Tropical Medicine.
16
Division of Infection and Immunity, University College London.
17
Health Protection Research Unit in Emerging and Zoonotic Infections, National Institute for Health Research, Liverpool, United Kingdom.

Abstract

Background:

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.

Methods:

We conducted a prospective, in-depth analysis of adult ischemic stroke patients presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, in 2011.

Results:

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).

Conclusions:

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.

KEYWORDS:

Africa; HIV; immune reconstitution syndrome; stroke; vasculopathy

PMID:
28931222
PMCID:
PMC5853476
DOI:
10.1093/infdis/jix340
[Indexed for MEDLINE]
Free PMC Article

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