Human immunodeficiency virus (HIV) and stroke: targets for intervention

Area of Science:

• Neurology
• Infectious Diseases
• Cardiology

Background:

• Human immunodeficiency virus (HIV) infection is linked to stroke through opportunistic infections, cardiac issues, and cerebral vasculopathy.
• HIV infection itself promotes endothelial activation and dyslipidemia, accelerating atherosclerosis.
• Stroke is an infrequent but significant complication of HIV, with incidence expected to rise due to combination antiretroviral therapy (cART).

Purpose of the Study:

• To explore the mechanisms by which HIV infection contributes to stroke.
• To analyze the impact of cART on stroke risk in HIV-infected individuals.
• To guide future research and clinical management of stroke in the context of HIV.

Main Methods:

• Review of existing literature on HIV, stroke, and antiretroviral therapy.
• Analysis of proposed pathophysiological pathways linking HIV and stroke.
• Discussion of the implications of cART on vascular health and stroke risk.

Main Results:

• HIV infection leads to both ischemic and hemorrhagic strokes, with ischemic stroke being more common.
• cART increases life expectancy but also contributes to pro-atherosclerotic effects, exacerbating vascular dysfunction.
• The combination of HIV-induced vascular disease and cART-induced dysfunction heightens the risk of atherosclerotic ischemic stroke.

Conclusions:

• HIV-associated stroke is multifactorial, involving direct viral effects and treatment-related complications.
• Current cART regimens, while life-saving, pose a significant risk for accelerated atherosclerosis and stroke.
• Future antiretroviral agents should aim to reduce viral load without inducing vascular dysfunction, and stroke should be a key outcome in HIV vascular disease research.