Central Nervous System Vasculopathy in HIV-Infected Children Enrolled in the Pediatric AIDS Clinical Trials Group 219/219C Study

Schieffelin, John S.; Williams, Paige L.; Djokic, Divna; Anderson, Jeffrey P.; Nachman, Sharon; Oleske, James M.; Seage, George R.; Dyke, Russell B. Van

doi:10.1093/jpids/pis095

Cited by 15 publications

(13 citation statements)

References 35 publications

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“… 2 , 3 The incidence of cerebrovascular events in pediatric patients with HIV infection is estimated to be 3.4 cases per 10000 person-years. 4 Human immunodeficiency virus–associated arteriopathy encompasses several forms of arterial diseases occurring in the absence of any cause other than HIV infection. The HIV–associated aneurysmal arteriopathy is a rare cerebrovascular complication of acquired immune deficiency syndrome (AIDS) and has been the subject of several case reports and case series involving children, and more recently adults, with AIDS.…”

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confidence: 99%

De Novo intracerebral aneurysm in a child with acquired immunodeficiency syndrome

Bakhaidar

Ahamed

Almekhlafi

et al. 2015

NSJ

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Human immunodeficiency virus (HIV) infection associated aneurysmal vasculopathy is a rare complication of HIV infection affecting the pediatric and adult population. We present a case of a 7-year-old male child known to have a congenitally acquired HIV infection presenting with a ruptured left distal internal carotid artery fusiform aneurysm that was diagnosed on MRI scans 6 months prior to his presentation. He underwent craniotomy and successful aneurysm reconstruction. He had uncomplicated postoperative course and experienced a good recovery. This case is among the few reported pediatric cases of HIV-associated cerebral arteriopathy to undergo surgery. We also reviewed the relevant literature of this rare condition.

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confidence: 99%

De Novo intracerebral aneurysm in a child with acquired immunodeficiency syndrome

Bakhaidar

Ahamed

Almekhlafi

et al. 2015

NSJ

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“…Despite the void of evidence from controlled trials in this area, the reports that exist suggest a trend towards treating these patients with thrombolysis or endovascular clot extraction to improve their clinical and functional outcome. However, it is clear that patients who commence treatment with antithrombotic agents of any type while they have only moderately disabling signs have a better outcome than those that are only treated when they are already locked-in [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…These techniques include clot aspiration, angioplasty and stenting, laser treatment, ultrasound, and clot retrieval [ 20 , 21 , 25 -28 ]. The Basilar Artery International Cooperation Study (BASICS) was a prospective observational study of 592 patients with radiologically confi rmed basilar artery occlusion [ 19 ]. In this study the patients were divided into three groups according to the treatment they received; antithrombotic therapy alone (AT), primary intravenous thrombolysis (IVT) including subsequent IA thrombolysis, or intra-arterial therapy (IAT) which included thrombolysis, mechanical clot retrieval, stenting or a combination of these treatments.…”

Section: Discussionmentioning

confidence: 99%

Stroke Medicine

2015

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“…Kure et al demonstrated the presence of HIV within the arterial wall of the circle of Willis and in the cerebral parenchy ma in a child who died of HIVrelated cerebral vascular ectasia and multiple infarcts [63]. Schieffelin et al, with 51 subjects with diagnoses suggestive of CNS vasculop athy among the 3338 HIV+ subjects and after review, excluded 27 as not being consistent with CNS vasculop athy [64]. They indicated that despite being a rare event, the incidence rate of stroke is higher than the reported incidence rate of stroke in the general paediatric pop ulation, so they concluded that there is increased in cidence of cerebrovascular events in HIV+ children, with the incidence among the HIV+ subjects being 2.4 times that of HEU subjects [64].…”

Section: Hiv and Stroke In Childrenmentioning

confidence: 99%

Human immunodeficiency virus and cerebrovascular diseases – review

Richard¹,

Tampouri²,

Sackey³

et al. 2017

HIV & AIDS Review

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Human immunodeficiency virus (HIV) is thought to increase the risk of cerebrovascular disease, although few data exist linking these two disease entities. The aetiology of vasculopathy in both adults and children with HIV remains unknown. However, it has been postulated that direct infection by HIV, immune complex deposition, and impaired regulation of the immune response are the likely causes. HIVassociated vasculopathy in the cerebral circulation encompasses several forms of arterial disease occurring in the absence of any cause other than HIV infection. It includes disease of extra cranial large arteries, intracranial medium sized arteries with or without aneurysm formation and small vessel disease. The pathology appears to differ across vessel types, and the exact mechanism by which HIV induces vessel wall damage in each case remains uncertain. Furthermore, immuno suppression secondary to HIV can predispose to opportunistic infections of the central nervous sys tem. These acquired immune deficiency syndrome (AIDS)defining infections include toxoplasmosis, cryptococcal meningitis, tuberculosis, cytomegalovirus, and progressive multifocal leukoencephalop athy secondary to JC virus reactivation, which can also present as cerebrovascularlike manifestation in patients with HIV. Although several causative mechanisms have been proposed for the relationship between HIV infection and cerebrovascular diseases, including HIVassociated dyslipidaemia, endo thelial dysfunction, inflammation, and hypercoagulability, the pathogenesis of HIVvasculopathy is not completely understood. Beside the above pathological entities, HIV itself has been implicated in the pathogenesis of cerebrovascular diseases, either through direct invasion and vessel wall destruc tion or cytokinemediated vascular remodelling.

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Central Nervous System Vasculopathy in HIV-Infected Children Enrolled in the Pediatric AIDS Clinical Trials Group 219/219C Study

Cited by 15 publications

References 35 publications

De Novo intracerebral aneurysm in a child with acquired immunodeficiency syndrome

De Novo intracerebral aneurysm in a child with acquired immunodeficiency syndrome

Stroke Medicine

Human immunodeficiency virus and cerebrovascular diseases – review

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