How are cerebrovascular diseases diagnosed and treated in HIV infection?

Updated: Apr 12, 2018
  • Author: Regina Krel, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

HIV infection seems to confer a 20–80% increased risk for ischemic and hemorrhagic stroke independent of other stroke-related risk factors. [26] Additionally, with improved treatment and survival, more HIV-infected patients reach an older age and are at risk for cerebrovascular diseases unrelated to HIV.

The increased risk of stroke in HIV infection is likely multifactorial. Established risk factors such as hyperlipidemia, hypertension, diabetes, and smoking seem to be more prevalent in HIV infection. Low levels of CD4+ and a high viral load, indicating worse immunodeficiency, are additional stroke risk factors. Protease inhibitors have been linked to metabolic syndrome and may increase the risk of small vessel disease and stroke. [20, 26]

In addition, as patients continue to live longer with HIV, they acquire the risk factors of stroke that are associated with advanced age. The presenece of these metabolic changes have been associated with subclinical cervical artery atherosclerosis, carotid artery plaques, and intracerebral small-vessel disease. [9]

Carotid intima-media thickness (c-IMT) and coronary artery calcium (CAC) progression are increasingly being used to predict vascular risk. A 3-year follow-up study of 255 HIV-infected adults found that although c-IMT and CAC progression rates were higher than expected for their respective age and risk groups, traditional cardiovascular risk factors are the strongest predictors of carotid and coronary atherosclerotic disease progression in this population. Aggressive cardiovascular risk reduction slows progression of atherosclerosis in patients with preexisting disease. [14]

In addition, cerebral aneurysms have been described in patients with HIV infection who are not on ART. At this time, no clear cause has been established but possible mechanisms include varicella-zoster virus infection or a consequence of HIV affecting blood vessels. [20]


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