Stroke in patients with human immunodeficiency virus infection

Abstract

Objective: To report the nature of stroke in Human Immunodeficiency Virus (HIV) infected patients in a region with high HIV seroprevalence and describe HIV-associated vasculopathy.

Methods: Patients with first ever stroke, infected with HIV, and prospectively included in the stroke register of the Groote Schuur Hospital/University of Cape Town stroke unit were identified and reviewed.

Results: Between 2000 and 2006, 67 of the 1087 (6,1%) stroke patients were HIV-infected. Of these, 91% (n=61) were younger than 46 years. Cerebral infarction occurred in 96% (n=64) of the HIV positive patients and intracerebral haemorrhage in 4% (n=3). HIV infected young strokes did not demonstrate hypertension, diabetes, hyperlipidaemia and smoking as significant risk factors for ischaemic stroke. Infection as a risk factor for stroke was significantly more common in HIV positive patients (p=0.018, OR 6.4, CI 3.1-13.2). In 52 (81%) patients with ischaemic stroke an aetiology was determined. Primary aetiologies comprised infectious meningitides/vasculitides in 18 (28%) patients, coagulopathy in 12 (19%) patients, and cardioembolism in 9 (14%) patients. Multiple aetiologies were present in 7(11%) of patients with ischaemic stroke. HIV–associated vasculopathy was identified in 13 (20%) patients. The HIV-associated vasculopathy manifested either extracranially (7 patients) as total or significant carotid occlusion or intracranially (6 patients) as medium vessel occlusion with or without fusiform aneurysmal dilation, stenosis and vessel caliber variation.

Conclusion: Investigation of HIV infected patients presenting with stroke will determine an aetiology in the majority of patients. In our cohort, 20% of patients demonstrated evidence of an HIV-associated vasculopathy.