AIDS/HIV Infection and Cerebrovascular Disease

The occurrence of cerebrovascular disease in patients with human immunodeficiency virus (HIV) infection has been reported mainly in advanced stages of the disease and was generally associated with nonbacterial thrombotic endocarditis, opportunistic infections, or tumors, although in recent series a large number of cryptogenic strokes were found, probably related to HIV vasculopathy. Recently a population-based study reported a strong association between acquired immunodeficiency syndrome (AIDS) and both ischemic stroke and intracerebral hemorrhage, with an incidence of 0.2% per year. However, with the advent of highly active retroviral therapy (HAART)-causing immune restoration in HAART-treated patients and avoiding early death and leading to a lengthening of the disease free-survival, an older population was created, which is at higher risk for stroke. Furthermore, recent evidence suggests that accelerated atherosclerosis may be a potential risk for stroke in these patients as it accompanies dyslipidemia and insulin resistance that were found to be more frequent among patients in the HAART regimen. The relationship of HIV infection and stroke is undergoing remarkable changes and epidemiological studies should be performed on aging HIV populations to state the impact of this new information on the incidence of cerebrovascular disease in HIV-infected patients and to identify factors that are associated with its occurrence.