Schaefer Jan H, Stephan Christoph, Foerch Christian, Pfeilschifter Waltraud
Department of Neurology, Goethe University, Frankfurt am Main, Germany.
Department of Internal Medicine, Infectious Diseases Division, Goethe University, Frankfurt am Main, Germany.
Eur Stroke J. 2020 Sep;5(3):252-261. doi: 10.1177/2396987320927672. Epub 2020 Jun 3.
The global incidence of ischemic stroke among patients with human immunodeficiency virus is increasing. The aim of this controlled case analysis was to study patient characteristics, stroke etiologies, and risk factors in human immunodeficiency virus-positive patients in a medical system with easy access to antiretroviral therapies.
We conducted a retrospective, observational study of human immunodeficiency virus-positive patients treated in our stroke unit and outpatient clinic in Germany between 2012 and 2018. A control group of all patients treated for acute ischemic stroke in 2018 was used to elicit possible differences in stroke localization, etiology, and distribution of risk factors.
Out of 3615 patients with an acute ischemic stroke, 24 (0.7%) were newly or previously diagnosed as human immunodeficiency virus-positive. Strokes in this cohort were caused by large-vessel disease (37.5%), small-vessel disease (20.8%), cryptogenic-embolism (20.8%), vasculitis (16.7%), and cardio-embolism (4.2%). Large-vessel disease-related strokes were more often located in the posterior circulation (77.8%). Compared to the control group, cardio-embolic strokes were less and vasculitis and large-vessel disease more frequent. Human immunodeficiency virus-positive patients were younger at stroke onset (53.7 ± 12.8 vs. 70.2 ± 14.6 years, p = 0.05).
Although the prevalence of human immunodeficiency virus-infection among patients treated for acute ischemic strokes appears low, this collective merits special attention due to a high burden of potentially modifiable risk factors and vasculitis.
Compared to previous studies, age at stroke onset was one of the highest, supporting the hypothesis that as antiretroviral therapy increases the life expectancy of people living with HIV/AIDS, they will be increasingly affected by cardiovascular disease. Human immunodeficiency virus-related cerebral vasculitis was associated with high mortality (75%).
人类免疫缺陷病毒（HIV）感染者中缺血性卒中的全球发病率正在上升。本对照病例分析的目的是研究在一个易于获得抗逆转录病毒疗法的医疗系统中，HIV阳性患者的特征、卒中病因及危险因素。
我们对2012年至2018年期间在德国我们的卒中单元和门诊接受治疗的HIV阳性患者进行了一项回顾性观察研究。以2018年所有接受急性缺血性卒中治疗的患者作为对照组，以找出卒中部位、病因及危险因素分布方面可能存在的差异。
在3615例急性缺血性卒中患者中，24例（0.7%）为新诊断或既往诊断为HIV阳性。该队列中的卒中由大血管疾病（37.5%）、小血管疾病（20.8%）、隐源性栓塞（20.8%）、血管炎（16.7%）和心源性栓塞（4.2%）引起。与大血管疾病相关的卒中更常位于后循环（77.8%）。与对照组相比，心源性栓塞性卒中较少，而血管炎和大血管疾病更常见。HIV阳性患者卒中发病时年龄较轻（53.7±12.8岁 vs. 70.2±14.6岁，p = 0.05）。
尽管在接受急性缺血性卒中治疗的患者中，HIV感染的患病率似乎较低，但由于潜在可改变的危险因素和血管炎负担较高，这一群体值得特别关注。
与既往研究相比，卒中发病年龄是最高的之一，这支持了以下假设，即随着抗逆转录病毒疗法延长了HIV/AIDS患者的预期寿命，他们将越来越多地受到心血管疾病的影响。与HIV相关的脑血管炎与高死亡率（75%）相关。
