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

Laura A Benjamin, Theresa J Allain, Henry Mzinganjira, Myles D Connor, Colin Smith, Sebastian Lucas, Elizabeth Joekes, Sam Kampondeni, Karen Chetcuti, Ian Turnbull, Mark Hopkins, Steve Kamiza, Elizabeth L Corbett, Robert S Heyderman, Tom Solomon

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)545-553
Number of pages9
JournalThe Journal of Infectious Diseases
Volume216
Issue number5
Early online date22 Jul 2017
DOIs
Publication statusPublished - 1 Sep 2017

Keywords

  • Adult
  • Aged
  • Anti-HIV Agents
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Case-Control Studies
  • Female
  • HIV
  • HIV Infections
  • Humans
  • Immune Reconstitution Inflammatory Syndrome
  • Malawi
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Stroke
  • Vasculitis
  • Viral Load
  • Journal Article

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