HIV Infection and Stroke: the Changing Face of a Rising Problem

Abstract

The reporting of stroke in HIV-infected subjects has faced several challenges that have limited one's ability to determine whether a direct association between cerebrovascular disease and HIV infection exists. With increased survival, aging of the HIV-infected cohorts is accompanied not infrequently by metabolic and lipid disorders, which are observed often in subjects on highly active antiretroviral therapy (HAART). Recent evidence for the development of premature atherosclerotic disease in this population calls for a revision of the association between stroke and HIV infection. The majority of strokes reported in the clinical and postmortem series were associated with underlying diseases. Intracranial hemorrhage was usually associated with underlying thrombocytopenia, primary central nervous system (CNS) lymphoma, or metastatic Kaposi’s sarcoma. The chapter discusses potential mechanisms of ischemic stroke in HIV-infected patients, and presents new insights into the mechanisms of stroke in HIV-infected patients. Pathological studies of a different vascular bed provide support for the possibility of an HIV-related vasculopathy inducing endothelial cell disturbance. Future studies will be required to better assess the macrovascular and microvascular complications that may result from HIV infection, the metabolic derangements induced by HAART, or both, as well as to determine the optimal treatment and prevention for this specific patient population.