Commentary – HIV-Induced Extracranial Carotid Ectasia and Stroke

HIV is a known risk factor for both ischemic and hemorrhagic stroke. Even with the widespread use of antiretroviral therapy, stroke incidence is higher in patients with HIV compared to non-HIV control subjects [1]. Ischemic stroke in patients with HIV are often deemed to be cryptogenic, but several possible etiologies for stroke have been identified in this population, including coagulopathy, opportunistic infection, cardioembolism and vasculopathy [2,3]. Our recent publication describes several cases of HIV vasculopathy with development of extracranial ectatic vasculature contributing to acute ischemic stroke in these patients [4]. We further described the various etiologies of stroke in the HIV population, emphasizing the pathophysiology of HIV-induced vasculopathy. In the present commentary, we briefly summarize the critical aspects of our recent publication and highlight our suggested algorithm for a more comprehensive work up of ischemic stroke in HIV positive patients.