The role of atherosclerosis in HIV-associated vasculopathy in young South African stroke patients

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2025-02-13 DOI:10.1111/hiv.13764

Eitzaz Sadiq, Angela Woodiwiss, Grace Tade, Jeremy Nel, Gavin Norton, Girish Modi

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Abstract

Background

HIV-associated vasculopathy is known to cause stroke in people living with HIV (PLWH). The role of atherosclerosis is unclear. We assessed the aetiology of vasculopathy in PLWH and tested the utility of markers of subclinical atherosclerosis to distinguish atherosclerotic (AV) from non-atherosclerotic vasculopathy (NAV).

Methods

This cross-sectional study recruited PLWH with stroke at a hospital in Johannesburg, South Africa, from 2014 to 2017. Patients with meningitis were excluded. Cerebrospinal fluid (CSF) was tested for multi-viral polymerase chain reaction, including varicella zoster virus (VZV). Once an aetiological category was assigned, carotid intima-media thickness (cIMT) and aortic pulse wave velocity (PWV) were compared in AV and NAV, and to predetermined thresholds for subclinical atherosclerosis (cIMT≥0.70 mm, PWV≥10.00 m/s).

Results

Some 28/85 PLWH (32.9%) vs. 9/109 (8.3%, p < 0.0001) people-without-HIV had vasculopathy on computed tomography angiography. Only four PLWH had AV. Compared with NAV (n = 11), those with AV were older (50.0 ± 4.1 vs. 39.2 ± 9.2 years, p = 0.04) and had more cardiovascular risk factors (median 2.0 [IQR 1.5–2.5] vs. 0.0 [IQR 0.0–1.0], p = 0.02). cIMT in AV was higher than in NAV (1.01 ± 0.07 mm [n = 4] vs. 0.63 ± 0.04 mm [n = 9], p < 0.001). All with AV had cIMT and PWV above the predetermined thresholds, while all except one with NAV were below. We found evidence of VZV in eight PLWH and HIV-associated vasculitis in six.

Conclusions

Vasculopathy in PLWH in our region appears to be predominantly non-atherosclerotic. cIMT and PWV were useful adjuncts in distinguishing AV from NAV. Despite excluding meningitis, VZV was implicated in a large proportion, emphasizing the likely underdiagnosis of this treatable infection. We thus recommend CSF VZV testing in all PLWH with stroke.

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动脉粥样硬化在南非年轻中风患者hiv相关血管病变中的作用

背景：已知HIV相关血管病变可导致HIV感染者（PLWH）中风。动脉粥样硬化的作用尚不清楚。我们评估了PLWH患者血管病变的病因，并测试了亚临床动脉粥样硬化标志物在区分动脉粥样硬化性（AV）和非动脉粥样硬化性血管病变（NAV）方面的效用。方法：本横断面研究招募了2014年至2017年在南非约翰内斯堡一家医院卒中的PLWH患者。排除脑膜炎患者。检测脑脊液（CSF）的多病毒聚合酶链反应，包括水痘带状疱疹病毒（VZV）。一旦确定了病因分类，将颈动脉内膜-中膜厚度（cIMT）和主动脉脉波速度（PWV）的AV和NAV进行比较，并与亚临床动脉粥样硬化的预定阈值（cIMT≥0.70 mm, PWV≥10.00 m/s）进行比较。结果：28/85 PLWH (32.9%) vs. 9/109 (8.3%) p结论：我们地区PLWH的血管病变似乎主要是非动脉粥样硬化性的。cIMT和PWV是区分AV和NAV的有用辅助手段。尽管排除了脑膜炎，但VZV与很大比例有关，强调了这种可治疗感染的可能诊断不足。因此，我们建议对所有伴有卒中的PLWH患者进行脑脊液VZV检测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.