HIV stroke risk: evidence and implications

Abstract

An estimated 34 million men, women, and children are infected with human immunodeficiency virus type 1 (HIV-1), the virus that causes acquired immunodeficiency syndrome (AIDS). Current technology cannot eradicate HIV-1, and most patients with HIV-1-infection (HIV+) will require lifelong treatment with combined antiretroviral therapy (cART). Stroke was recognized as a complication of HIV-1 infection since the early days of the epidemic. Potential causes of stroke in HIV-1 include opportunistic infections, tumors, atherosclerosis, diabetes, hypertension, autoimmunity, coagulopathies, cardiovascular disease, and direct HIV-1 infection of the arterial wall. Ischemic stroke has emerged as a particularly significant neurological complication of HIV-1 and its treatment due to the aging of the HIV+ population, chronic HIV-1 infection, inflammation, and prolonged exposure to cART. New prevention and treatment strategies tailored to the needs of the HIV+ population are needed to address this issue.

Cerebrovascular events in HIV-infected patients: an analysis of a cohort of 3203 HIV+ patients during the times of cART

“…HIV associated vasculopathy has become increasingly relevant in literature in the context of CVE in HIVinfection [28,36]. So far no consistent definition has been used for this phenomenon.…”

“…It includes aneurysm formation, accelerated atherosclerosis (through cART or chronic inflammation), vasculitis (as a direct result of HIV) and impaired cerebral blood flow [28]. A direct influence of the HI-virus on the development of vasculitis remains uncertain [28,36]. Through invasion of perivascular cells, especially in the cerebrovascular milieu, HIV may initiate an inflammatory process that leads to vascular disease and accelerated atherosclerosis [36].…”

HIV-1 induces in vivo platelet activation by enhancing platelet NOX2 activity

“…4,5 Ischemic complications include not only coronary, but also cerebrovascular disease, affecting intracranial vessels and leading to progressive neurological and cognitive impairment. 6,7 Platelet activation plays a crucial role on the onset of atherosclerotic complications, 8 and recent evidences suggest that patients with HIV-1 infection disclose an enhanced platelet activation. 9 Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase is a key enzyme involved in reactive oxygen species (ROS) production.…”

Interdisciplinary management of multidrug-resistant tuberculosis in an HIV-infected patient: case report

“…In all these organs and tissues permanent changes in organ structures, such as bone erosion or enlarged lymph nodes, may be observed [11]. It is also important to note that stroke is one of the frequent complications of when TB process involves the central nervous system [12,13].…”