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AIDS and cerebrovascular disease
1Department of Epidemiology and Preventive Medicine, University of Maryland at Baltimore, USA.
Insights
Cerebrovascular disease (CVD) is rarely reported in human immunodeficiency virus (HIV) infection. Limited data suggest a low incidence of stroke in acquired immunodeficiency syndrome (AIDS) patients, necessitating further research.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Neurological complications are common in human immunodeficiency virus (HIV) infection.
- Cerebrovascular disease (CVD) is infrequently reported in HIV/AIDS patients.
Purpose of the Study:
- To review existing literature on the association between stroke and acquired immunodeficiency syndrome (AIDS).
Main Methods:
- MEDLINE search (mid-1976 to December 1994) using keywords: AIDS, CVD, HIV-1.
- Included clinical stroke reports and autopsy series in HIV-infected individuals.
- Analyzed study type, population, stroke characteristics, and associated AIDS conditions.
Main Results:
- Reviewed 6 clinical and 11 autopsy series, totaling 1885 cases.
- Neurological complications occurred in 40% of cases, with stroke syndrome in only 1.3%.
- Ischemic infarcts (due to endocarditis or infections) were more common than hemorrhages (associated with thrombocytopenia, lymphoma, Kaposi's sarcoma).
- Autopsy CVD findings often did not correlate with clinical stroke.
- Insufficient data to determine AIDS risk factors' role in CVD.
Conclusions:
- The association between AIDS and stroke remains unclear due to data limitations.
- Further research is required to establish the epidemiology of CVD in AIDS patients.
Background:
Although neurological complications of human immunodeficiency virus (HIV) infection are common, the presence of cerebrovascular disease (CVD) has been seldom reported. The purpose of this report is to review available data on the association between stroke and acquired immunodeficiency syndrome (AIDS).
Summary Of Review:
A review of all literature published between mid-1976 and December 1994 was performed through a MEDLINE search with the following key words: AIDS, CVD, human T-cell lymphotropic virus type III, and HIV-1. Only reports of clinical stroke in patients with AIDS or HIV infection and autopsy series with stroke findings were selected. The type of study, population, number of stroke patients, subtype and etiology of stroke, and associated AIDS conditions were described. Six clinical series and 11 autopsy series were found, with a total of 1885 cases with AIDS, AIDS-related complex, and HIV carriers. Forty percent had a neurological complication, but only 1.3% had a stroke syndrome. Ischemic infarcts were more common than intracerebral hemorrhages. Cerebral infarcts were generally due to nonbacterial thrombotic endocarditis or concomitant opportunistic central nervous system infection, and intracerebral hemorrhages were usually associated with thrombocytopenia, primary central nervous system lymphoma, and metastatic Kaposi's sarcoma. Autopsy findings of CVD were generally not related with clinical stroke before death. Data are not available to determine the role of risk factors for AIDS in CVD.
Conclusions:
Because of limitations of the available data, it is still not clear whether there is an association between AIDS and stroke. Further studies are needed to better define the epidemiology of CVD in association with AIDS.