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Canadian Journal of Cardiology

Stroke in HIV

Published:December 05, 2018DOI:https://doi.org/10.1016/j.cjca.2018.11.032

      Abstract

      Stroke is a heterogeneous disease in persons living with human immunodeficiency virus (HIV). HIV is thought to increase the risk of stroke through both HIV-related and traditional stroke risk factors, which vary with respect to the patient’s age and clinical characteristics. Numerous studies show that detectable viremia and immunosuppression increase the risk of stroke across all ages, whereas traditional risk factors are more common in the aging population with HIV. As persons living with HIV age and acquire traditional stroke risk factors, the prevalence of stroke will likely continue to increase. Large- and small-vessel disease are the most common causes of stroke, although it is important to evaluate for infectious etiology as well. Research regarding the management of stroke in patients with HIV is scant, and recommendations often parallel those for the general population. Treatment of HIV and effective reduction of traditional stroke risk factors is important to reduce the risk of stroke in persons living with HIV. Future research will help elucidate the pathophysiology of HIV and stroke risk, investigate sex differences in stroke risk, and evaluate the safety and benefits of standard stroke preventative measures and HIV-specific interventions in this population.

      Résumé

      L’accident vasculaire cérébral (AVC) est une maladie hétérogène chez les personnes vivant avec le virus de l’immunodéficience humaine (VIH). On pense que le VIH accroît le risque d’AVC par l’intermédiaire de facteurs de risques tant liés au VIH que traditionnels qui varient en fonction de l’âge et des caractéristiques cliniques du patient. De nombreuses études montrent que la virémie décelable et l’immunosuppression augmentent le risque d’AVC sans égard à l’âge, alors que les facteurs de risque traditionnels sont plus fréquents dans la population plus âgée infectée par le VIH. À mesure que les personnes vivant avec le VIH vieillissent et acquièrent des facteurs de risque d’AVC traditionnels, la prévalence de l’AVC est appelée à augmenter. Si les affections touchant les gros et les petits vaisseaux sont les causes les plus courantes d’AVC, il n’en demeure pas moins important d’évaluer aussi la possibilité d’une étiologie infectieuse. Les recherches sur la prise en charge de l’AVC chez les patients infectés par le VIH sont rares, et les recommandations sont souvent les mêmes que celles visant la population générale. Le traitement du VIH et la réduction réelle des facteurs de risque d’AVC traditionnels jouent un rôle important dans la réduction du risque d’AVC chez les personnes vivant avec le VIH. Les recherches futures contribueront à préciser la physiopathologie du VIH et du risque d’AVC, à analyser les différences entre les sexes quant au risque d’AVC et à évaluer l’innocuité et les effets bénéfiques des mesures standard de prévention de l’AVC et des interventions ciblant le VIH dans cette population.
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