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

doi:10.1093/infdis/jix340

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 journal › Article › peer-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 language	English
Pages (from-to)	545-553
Number of pages	9
Journal	The Journal of Infectious Diseases
Volume	216
Issue number	5
Early online date	22 Jul 2017
DOIs	https://doi.org/10.1093/infdis/jix340
Publication status	Published - 1 Sept 2017

Keywords / Materials (for Non-textual outputs)

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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10.1093/infdis/jix340

jix340
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Benjamin, L. A., Allain, T. J., Mzinganjira, H., Connor, M. D., Smith, C., Lucas, S., Joekes, E., Kampondeni, S., Chetcuti, K., Turnbull, I., Hopkins, M., Kamiza, S., Corbett, E. L., Heyderman, R. S., & Solomon, T. (2017). The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke. The Journal of Infectious Diseases, 216(5), 545-553. https://doi.org/10.1093/infdis/jix340

@article{0aa0465597b44194829c886aeb6eb421,

title = "The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke",

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 = "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",

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

year = "2017",

month = sep,

day = "1",

doi = "10.1093/infdis/jix340",

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volume = "216",

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issn = "0022-1899",

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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, vol. 216, no. 5, pp. 545-553. https://doi.org/10.1093/infdis/jix340

TY - JOUR

T1 - The Role of Human Immunodeficiency Virus-Associated Vasculopathy in the Etiology of Stroke

AU - Benjamin, Laura A

AU - Allain, Theresa J

AU - Mzinganjira, Henry

AU - Connor, Myles D

AU - Smith, Colin

AU - Lucas, Sebastian

AU - Joekes, Elizabeth

AU - Kampondeni, Sam

AU - Chetcuti, Karen

AU - Turnbull, Ian

AU - Hopkins, Mark

AU - Kamiza, Steve

AU - Corbett, Elizabeth L

AU - Heyderman, Robert S

AU - Solomon, Tom

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Anti-HIV Agents

KW - Antiretroviral Therapy, Highly Active

KW - CD4 Lymphocyte Count

KW - Case-Control Studies

KW - Female

KW - HIV

KW - HIV Infections

KW - Humans

KW - Immune Reconstitution Inflammatory Syndrome

KW - Malawi

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Risk Factors

KW - Stroke

KW - Vasculitis

KW - Viral Load

KW - Journal Article

U2 - 10.1093/infdis/jix340

DO - 10.1093/infdis/jix340

M3 - Article

C2 - 28931222

SN - 0022-1899

VL - 216

SP - 545

EP - 553

JO - The Journal of Infectious Diseases

JF - The Journal of Infectious Diseases

IS - 5

ER -

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

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