Stroke Caused by Human Immunodeficiency Virus–Associated Vasculopathy?

Gilden, Donald H.; Nagel, Maria A.

doi:10.1001/archneur.64.5.763-a

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…For example, Tipping and colleagues [70] described a 27-year-old HIV-infected woman who presented with stroke and a CD4 count of 14 cells/μl and who demonstrated fusiform aneurysmal dilation of the left internal carotid artery and left middle cerebral artery upon imaging. Although VZV vasculopathy, even in the absence of VZV rash, was a likely strong possibility in light of her immunosuppressed state, cerebral artery pathology and the presence of a CSF pleocytosis, the patient’s CSF was not tested for VZV DNA or anti-VZV IgG antibody, nor were her affected cerebral arteries tested for VZV antigen staining [71]. At autopsy, HIV p24 antigen was not found in the affected cerebral arteries.…”

Section: Hiv Vasculopathymentioning

confidence: 99%

Virus Vasculopathy and Stroke: An Under-Recognized Cause and Treatment Target

Nagel¹,

Mahalingam²,

Cohrs³

et al. 2010

IDDT

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While arteriosclerotic disease and hypertension, with or without diabetes, are the most common causes of stroke, viruses may also produce transient ischemic attacks and stroke. The three mostwell studied viruses in this respect are varicella zoster virus (VZV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV), all of which are potentially treatable with antiviral agents. Productive VZV infection in cerebral arteries after reactivation (zoster) or primary infection (varicella) has been documented as a cause of ischemic and hemorrhagic stroke, aneurysms with subarachnoid and intracerebral hemorrhage, arterial ectasia and as a co-factor in cerebral arterial dissection. CMV has been suggested to play a role in the pathogenesis of arteriosclerotic plaques in cerebral arteries. HIV patients have a small but definite increased incidence of stroke which may be due to either HIV infection or opportunistic VZV infection in these immunocompromised individuals. Importantly, many described cases of vasculopathy in HIV-infected patients were not studied for the presence of anti-VZV IgG antibody in CSF, a sensitive indicator of VZV vasculopathy. Unlike the well-documented role of VZV in vasculopathy, evidence for a causal link between HIV or CMV and stroke remains indirect and awaits further studies demonstrating productive HIV and CMV infection of cerebral arteries in stroke patients. Nonetheless, all three viruses have been implicated in stroke and should be considered in clinical diagnoses. Keywords Virus vasculopathy; VZV; HIV; CMV VIRAL CAUSES OF STROKEStroke is a common cause of mortality and morbidity worldwide [1]. While established risk factors, such as hypertension, diabetes, obesity and hypercholesterolemia have been identified and are targets for stroke prevention, viral infections have also emerged as risk factors for stroke. Identification of viruses that directly cause stroke, as evidenced by direct invasion of cerebral arteries corresponding to areas of infarction, would provide therapeutic targets for stroke prevention. Varicella zoster virus (VZV), human immunodeficiency virus (HIV) and cytomegalovirus (CMV) have all been associated with stroke. However, VZV is The incidence and prevalence of stroke caused by VZV is unknown, although estimates in children reveal that varicella accounts for 7 to 31% of arterial ischemic stroke [18,19], with 1 in 15,000 cases of varicella associated with stroke [18]. In transient cerebral arteriopathy of childhood, stroke is preceded by varicella in 44% of cases [20]. In adults, VZV vasculopathy is more common in immunocompromised than in immunocompetent individuals. In immunocompromised adults, VZV infection of the central nervous system (CNS) was detected in 1.5 to 4.4% of autopsy cases [21][22][23]. In postmortem studies of HIVinfected individuals, VZV vasculopathy occurred more frequently late in the course of infection when there was significant CD4+ depletion [24,25]. CLINICAL FEATURES AND DIAGNOSISIn adults, the typical clinical presentation of stroke...

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Section: Hiv Vasculopathymentioning

confidence: 99%

Virus Vasculopathy and Stroke: An Under-Recognized Cause and Treatment Target

Nagel¹,

Mahalingam²,

Cohrs³

et al. 2010

IDDT

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“…Ischemic stroke occurs to a greater extent in PLHIV in SSA when comparing different types of cerebrovascular accidents. In support, 90% of stroke-related mortalities occur due to ischemic stroke compared with cerebral hemorrhage, although these results are not always supported in the literature (23,26,75). The typical clinical presentation of strokes as focal neurological deficiency occurs in PLHIV; however, atypical strokes (e.g., acute confusion, fever, unconsciousness) are more common (23).…”

Section: Strokementioning

confidence: 96%

HIV-related cardiovascular diseases: the search for a unifying hypothesis

Dominick

Midgley

Swart

et al. 2020

American Journal of Physiology-Heart and Circulatory Physiology

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Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.

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Non-atherosclerotic Cerebral Vasculopathies

Dafer,

Osteraas

2024

Ischemic Stroke Therapeutics

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Stroke Caused by Human Immunodeficiency Virus–Associated Vasculopathy?

Cited by 4 publications

References 8 publications

Virus Vasculopathy and Stroke: An Under-Recognized Cause and Treatment Target

Virus Vasculopathy and Stroke: An Under-Recognized Cause and Treatment Target

HIV-related cardiovascular diseases: the search for a unifying hypothesis

Non-atherosclerotic Cerebral Vasculopathies

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