Benjamin Laura A, Allain Theresa J, Mzinganjira Henry, Connor Myles D, Smith Colin, Lucas Sebastian, Joekes Elizabeth, Kampondeni Sam, Chetcuti Karen, Turnbull Ian, Hopkins Mark, Kamiza Steve, Corbett Elizabeth L, Heyderman Robert S, Solomon Tom
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre.
Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, United Kingdom.
J Infect Dis. 2017 Sep 1;216(5):545-553. doi: 10.1093/infdis/jix340.
Human immunodeficiency virus (HIV) infection is a recognized risk factor for stroke among young populations, but the exact mechanisms are poorly understood. We studied the clinical, radiologic, and histologic features of HIV-related ischemic stroke to gain insight into the disease mechanisms.
We conducted a prospective, in-depth analysis of adult ischemic stroke patients presenting to Queen Elizabeth Central Hospital, Blantyre, Malawi, in 2011.
We recruited 64 HIV-infected and 107 HIV-uninfected patients. Those with HIV were significantly younger (P < .001) and less likely to have established vascular risk factors. Patients with HIV were more likely to have large artery disease (21% vs 10%; P < .001). The commonest etiology was HIV-associated vasculopathy (24 [38%]), followed by opportunistic infections (16 [25%]). Sixteen of 64 (25%) had a stroke soon after starting antiretroviral therapy (ART), suggesting an immune reconstitution-like syndrome. In this group, CD4+ T-lymphocyte count was low, despite a significantly lower HIV viral load in those recently started on treatment (P < .001).
HIV-associated vasculopathy and opportunistic infections are common causes of HIV-related ischemic stroke. Furthermore, subtypes of HIV-associated vasculopathy may manifest as a result of an immune reconstitution-like syndrome after starting ART. A better understanding of this mechanism may point toward new treatments.
人类免疫缺陷病毒（HIV）感染是年轻人群中公认的中风危险因素，但确切机制尚不清楚。我们研究了HIV相关缺血性中风的临床、影像学和组织学特征，以深入了解疾病机制。
我们对2011年在马拉维布兰太尔伊丽莎白女王中央医院就诊的成年缺血性中风患者进行了前瞻性深入分析。
我们招募了64名HIV感染患者和107名未感染HIV的患者。HIV感染者明显更年轻（P <.001），且患已确定的血管危险因素的可能性更小。HIV感染者更易患大动脉疾病（21%对10%；P <.001）。最常见的病因是HIV相关血管病变（24例[38%]），其次是机会性感染（16例[25%]）。64名患者中有16名（25%）在开始抗逆转录病毒治疗（ART）后不久发生中风，提示存在免疫重建样综合征。在这组患者中，尽管近期开始治疗的患者HIV病毒载量显著降低（P <.001），但CD4 + T淋巴细胞计数仍很低。
HIV相关血管病变和机会性感染是HIV相关缺血性中风的常见原因。此外，HIV相关血管病变的亚型可能在开始ART后因免疫重建样综合征而出现。更好地理解这一机制可能指向新的治疗方法。
