DOI: https://doi.org/10.25305/unj.98094

Intracranial vascular complications in AIDS

Yuris L. Dzenis, Zanda Yu. Arajuma, Elina E. Liepina, Eva I. Voita

Abstract


The article analyzed intracranial pathomorphological changes in HIV patients as well as describes vessel wall changes leading to ischemic or hemorrhagic stroke. There are considered etiological factors for ischemic and hemorrhagic stroke in HIV patients. The article describes varied pathological processes and morphological changes in brain vessels which are called HIV-associated cerebral vasculopathy. Radiologically HIV-associated cerebral vasculopathy is characterized by fusiform aneurysms, dolichoectasia, artery stenosis or occlusion. Stroke clinical manifestation is the same for patients with HIV as for the other population, although the average age in HIV patients is much younger. The principles for stroke therapy are the same in HIV patients as in general population. Drug and surgical treatment strategies are both used. The most common surgical method is endovascular technique. Anti-stroke therapy is recommended to be completed with antiretroviral therapy being continued.


Keywords


HIV; AIDS; antiretroviral therapy; HIV-associated cerebral vasculopathy; fusiform aneurysm; stenosis; occlusion; stroke

References


1. Yakovlev NA, Zhulev NM, Slyusar TA. Neyrospid: Nevrologicheskie rasstroystva pri VICh-infektsii/ SPIDe. Moscow: Meditsinskoe informatsionnoe agenstvo; 2005. Russian.

2. Granitov VM. Gerpesvirusnaya infektsiya. Moscow: Meditsinskaya kniga; 2001. Russian.

3. Zavalishin IA. [Fundamental and applied studies of AIDS of the nervous system. A new stage in the study of slow infections of the nervous system]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91(2):3-8. Russian. [PubMed]

4. Nyamweya S, Hegedus A, Jaye A, Rowland-Jones S, Flanagan KL, Macallan DC.Comparing HIV-1 and HIV-2 infection: Lessons for viral immunopathogenesis. RevMed Virol. 2013 Jul;23(4):221-40. [CrossRef] [PubMed]

5. Regamey N, Harr T, Battegay M, Erb P. Downregulation of Bcl-2, but not of Bax or Bcl-x, is associated with T lymphocyte apoptosis in HIV infection and restoredby antiretroviral therapy or by interleukin 2. AIDS Res Hum Retroviruses. 1999 Jun 10;15(9):803-10. [CrossRef] [PubMed]

6. Fauci AS. Cytokine regulation of HIV expression. Lymphokine Res. 1990 Winter; 9(4):527-31. [PubMed]

7. Korsunskaya LL, Shiyan SV. [Features of Pathogenesis and Clinical Course of Cerebrovascular Diseases HIV-Positive Patients]. International Neurological Journal. . 2011;(4):66-70. Russian. Available from: http://www.mif-ua.com/archive/article/18399

8. Evtushenko SK, Derevyanko IN. Neyrospid kak odna iz aktual’neyshikh problem sovremennoy prakticheskoy nevrologii. International Neurological Journal. 2006;5(9). Russian. Available from: http://www.mif-ua.com/archive/article/2406

9. Wigdahl B, Kunsch C. Roleof HIV in human nervous system dysfunction. AIDS Res Hum Retroviruses. 1989 Aug;5(4):369-74. Review. [CrossRef] [PubMed]

10. Malashkhiia IuA, Nadareishvili ZG, Malashkhiia NIu, Malashkhiia VIu. [Brain as an organ of immunity]. Zh Nevrol Psikhiatr Im S S Korsakova. 1999;99(9):62-5. Review. Russian. [PubMed]

11. Vereshchagin NV, Milovidov YuK, Gulevskaya TS. Nevrologicheskie aspekty sindroma priobretennogo immunnogo defitsita. Analiticheskiy obzor zarubezhnoy literatury. Meditsinskiy referativnyy zhurnal. 1989;9(1):3-16. Russian.

12. Pokrovskiy VV, Ermak TN, Belyaeva VV, Yurin OG. VICh-infektsiya: klinika, diagnostika i lechenie. Moscow: Meditsina; 2000. Russian.

13. Shtul’man DR, Levin OS. Nevrologiya: Spravochnik prakticheskogo vracha. 2nd ed. Moscow: MEDpress-inform; 2002. Russian.

14. McArthur JC, Colen DF, Farzedegan H, Cornblath DR, Selnes OA, Ostrow D, Johnson RT, Phair J, Polk BF. Cerebrospinal fluid abnoralities in homosexual men with and without neuropsychiatric findings. Ann Neurol. 1988;23, Suppl 1: S34-7. [CrossRef] [PubMed]

15. McGuire D, Greene WC. Neurological damage in HIV infection. In: Lever AML, ed. The Molecular Biology of HIV/AIDS. New York: John Wiley & Sons; 1996.

16. Resnick L, Berger JR, Shapshak P, Tourtellotte WW. Early penetration of theblood-brain-barrier by HIV. Neurology. 1988 Jan;38(1):9-14. [CrossRef] [PubMed]

17. Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg. 1985 Apr;62(4):475-95. Review. [CrossRef] [PubMed]

18. Simpson DM, Tagliati M. Neurologic manifestations of HIV infection. Ann Intern Med. 1994 Nov 15;121(10):769-85. Review. Erratum in: Ann Intern Med 1995 Feb 15;122(4):317. [CrossRef] [PubMed]

19. Ciricillo SF, Rosenblum ML. Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg. 1990 Nov;73(5):720-4. [CrossRef] [PubMed]

20. Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H; Centers for Disease Control and Prevention (CDC); National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009 Apr 10;58(RR-4):1-207; quiz CE1-4. [PubMed] Available from: https://www.cdc.gov/mmWR/preview/mmwrhtml/rr5804a1.htm

21. Brooks JT, Kaplan JE, Holmes KK, Benson C, Pau A, Masur H. HIV-associated opportunistic infections--going, going, but not gone: the continued need for prevention and treatment guidelines. Clin Infect Dis. 2009 Mar 1;48(5):609-11. Review. [CrossRef] [PubMed]

22. Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol. 2012 Oct;11(10):878-90. Review. [CrossRef] [PubMed]

23. Micheloud D, Berenguer J, Guzmбn-Fulgencio M, Campos Y, Garcнa-Бlvarez M, Catalбn P, Cosнn J, Miralles P, Lуpez JC, Resino S. European mitochondrial DNA haplogroups and metabolic disorders in HIV/HCV-coinfected patients on highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2011 Dec 1;58(4):371-8. [CrossRef] [PubMed]

24. de Gaetano Donati K, Rabagliati R, Tumbarello M, Tacconelli E, Amore C, Cauda R, Lacoviello L. Increased soluble markers of endothelial dysfunction in HIV-positive patients under highly active antiretroviral therapy. AIDS. 2003 Mar 28;17(5):765-8. [CrossRef] [PubMed]

25. Corral I, Quereda C, Moreno A, Pйrez-Elнas MJ, Dronda F, Casado JL, Muriel A, Masjuбn J, Alonso-de-Leciсana M, Moreno S. Cerebrovascular ischemic events in HIV-1-infected patients receiving highly active antiretroviral therapy: incidence and risk factors. Cerebrovasc Dis. 2009;27(6):559-63. [CrossRef] [PubMed]

26. Ross AC, Rizk N, O’Riordan MA, Dogra V, El-Bejjani D, Storer N, Harrill D, Tungsiripat M, Adell J, Mc Comsey GA. Relationship between inflammatory markers, endothelial activation markers, and carotid intima-media thickness in HIV-infected patients receiving antiretroviral therapy. Clin Infect Dis. 2009 Oct1;49(7):1119-27. [CrossRef] [PubMed]

27. Harmsen MJ, Browne JL, Venter F, Klipstein-Grobusch K, Rijken MJ. The association between HIV (treatment), pregnancy serum lipid concentrations and pregnancy outcomes: a systematic review. BMC Infect Dis. 2017 Jul 11;17(1):489. [CrossRef] [PubMed] [PubMed Central]

28. Soepnel LM, Norris SA, Schrier VJ, Browne JL, Rijken MJ, Gray G, Klipstein-Grobusch K. The association between HIV, antiretroviral therapy, and gestational diabetes mellitus. AIDS. 2017 Jan 2;31(1):113-125. Review. [CrossRef] [PubMed]

29. Chi D, Henry J, Kelley J, Thorpe R, Smith JK, Krishnaswamy G. The effects of HIV infection on endothelial function. Endothelium. 2000;7(4):223-42. Review. [CrossRef] [PubMed]

30. Kuller LH, Tracy R, Belloso W, DeWit S, Drummond F, Lane HC, Ledergerber B, Lundgren J, Neuhaus J, Nixon D, Paton NI, Neaton JD; INSIGHT SMART StudyGroup. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med. 2008 Oct 21;5(10):e203. [CrossRef] [PubMed]

31. Burdo TH, Lo J, Abbara S, Wei J, DeLelys ME, Preffer F, Rosenberg ES, Williams KC, Grinspoon S. Soluble CD163, a novel marker of activated macrophages, is elevated and associated with noncalcified coronary plaque in HIV-infected patients. J Infect Dis. 2011 Oct 15;204(8):1227-36. [CrossRef] [PubMed] [PubMed Central]

32. Edwards NJ, Grill MF, Choi HA, Ko NU. Frequency and Risk Factors for Cerebral Arterial Disease in a HIV/AIDS Neuroimaging Cohort. Cerebrovasc Dis. 2016;41(3-4):170-6. [CrossRef] [PubMed]

33. Chetty R, Batitang S, Nair R. Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol. 2000 Mar;31(3):374-9. [CrossRef] [PubMed]

34. Lefeuvre D, Liebenberg L, Taylor A. Intracranial Arterial Dissection Related to HIV Infection. A Case Report with Histology. Interv Neuroradiol. 2005 Dec 20;11(4):387-91. [CrossRef] [PubMed]

35. Taylor A, Lefeuvre D, Levy A, Candy S. Arterial dissection and subarachnoid haemorrhage in human immunodeficiency virus-infected patients. A report of three cases. Interv Neuroradiol. 2004 Jun 29;10(2):137-43. [CrossRef] [PubMed]

36. Kure K, Park YD, Kim TS, Lyman WD, Lantos G, Lee S, Cho S, Belman AL, Weidenheim KM, Dickson DW. Immunohistochemical localization of an HIV epitopeincerebral aneurysmal arteriopathy in pediatric acquired immunodeficiency syndrome (AIDS). Pediatr Pathol. 1989;9(6):655-67. [CrossRef] [PubMed]

37. Joshi VV, Pawel B, Connor E, Sharer L, Oleske JM, Morrison S, Marin-Garcia J. Arteriopathy in children with acquired immune deficiency syndrome. Pediatr Pathol. 1987;7(3):261-75. [CrossRef] [PubMed]

38. Thawani JP, Nayak NR, Pisapia JM, Petrov D, Pukenas BA, Hurst RW, Smith MJ. Aneurysmal vasculopathy in human-acquired immunodeficiency virus-infected adults: Imaging case series and review of the literature. Interv Neuroradiol. 2015 Aug;21(4):441-50. [CrossRef] [PubMed]

39. Hag AM, Kristoffersen US, Pedersen SF, Gutte H, Lebech AM, Kjaer A. Regional gene expression of LOX-1, VCAM-1, and ICAM-1 in aorta of HIV-1 transgenic rats. PLoS One. 2009 Dec 4;4(12):e8170. [CrossRef] [PubMed] [PubMed Central]

40. Abi F, el Fares F, el Moussaoui A, Laaroussi H, Touzani K, Zerouali N. [Caustic lesions of the upper digestive tract. Apropos of 191 cases]. J Chir (Paris). 1986 Jun-Jul;123(6-7):390-4. French. [PubMed]

41. Kline ER, Sutliff RL. The roles of HIV-1 proteins and antiretroviral drug therapy in HIV-1-associated endothelial dysfunction. J Investig Med. 2008 Jun;56(5):752-69. Review. [CrossRef] [PubMed] [PubMed Central]

42. Ortiz G, Koch S, Romano JG, Forteza AM, Rabinstein AA. Mechanisms of ischemic stroke in HIV-infected patients. Neurology. 2007 Apr 17;68(16):1257-61. [CrossRef] [PubMed]

43. Goldstein DA, Timpone J, Cupps TR. HIV-associated intracranial aneurysmal vasculopathy in adults. J Rheumatol. 2010 Feb;37(2):226-33. Review. [CrossRef] [PubMed]

44. Nagel MA. Varicella zoster virus vasculopathy: clinical features and pathogenesis. J Neurovirol. 2014 Apr;20(2):157-63. Review. [CrossRef] [PubMed]

45. Sen S, Rabinstein AA, Elkind MS, Powers WJ. Recent developments regarding human immunodeficiency virus infection and stroke. Cerebrovasc Dis. 2012;33(3):209-18. Review. [CrossRef] [PubMed]

46. Ovbiagele B, Nath A. Increasing incidence of ischemic stroke in patients with HIV infection. Neurology. 2011 Feb 1;76(5):444-50. [CrossRef] [PubMed]

47. Tipping B, de Villiers L, Wainwright H, Candy S, Bryer A. Stroke in patients with human immunodeficiency virus infection. J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1320-4. [CrossRef] [PubMed]

48. Heikinheimo T, Chimbayo D, Kumwenda JJ, Kampondeni S, Allain TJ. Stroke outcomes in Malawi, a country with high prevalence of HIV: a prospective follow-up study. PLoS One. 2012;7(3):e33765. [CrossRef] [PubMed]

49. Kumwenda JJ, Mateyu G, Kampondeni S, van Dam AP, van Lieshout L, Zijlstra EE. Differential diagnosis of stroke in a setting of high HIV prevalence in Blantyre, Malawi. Stroke. 2005 May;36(5):960-4. [CrossRef] [PubMed]

50. Tipping B, de Villiers L, Candy S, Wainwright H. Stroke caused by human immunodeficiency virus-associated intracranial large-vessel aneurysmal vasculopathy. Arch Neurol. 2006 Nov;63(11):1640-2. [CrossRef] [PubMed]

51. Sharfstein SR, Ahmed S, Islam MQ, Najjar MI, Ratushny V. Case of moyamoya disease in a patient with advanced acquired immunodeficiency syndrome. J Stroke Cerebrovasc Dis. 2007 Nov-Dec;16(6):268-72. [CrossRef] [PubMed]

52. Bhagavati S, Choi J. Rapidly progressive cerebrovascular stenosis and recurrent strokes followed by improvement in HIV vasculopathy. Cerebrovasc Dis. 2008;26(4):449-52. [CrossRef] [PubMed]

53. Baeesa SS, Bakhaidar M, Almekhlafi MA, Madani TA. Human ImmunodeficiencyVirus-Associated Cerebral Aneurysmal Vasculopathy: A Systematic Review. World Neurosurg. 2016 Mar;87:220-9. Review. [CrossRef] [PubMed]

54. Mahadevan A, Tagore R, Siddappa NB, Santosh V, Yasha TC, Ranga U, Chandramouli BA, Shankar SK. Giant serpentine aneurysm of vertebrobasilar artery mimicking dolichoectasia--an unusual complication of pediatric AIDS. Report of a case with review of the literature. Clin Neuropathol. 2008 Jan-Feb;27(1):37-52.[CrossRef] [PubMed]

55. Petropoulou F, Mostrou G, Papaevangelou V, Theodoridou M. Central nervous system aneurysms in childhood AIDS. AIDS. 2003 Jan 24;17(2):273-5. [CrossRef] [PubMed]

56. Miyamoto S, Hara T, Tabei Y, Honma H, Kondo T, Oka S. Aneurysmal subarachnoid hemorrhagein a patient with human immunodeficiency virus type 1 infection. Casereport. Neurol Med Chir (Tokyo). 2006 Jul;46(7):348-52. [CrossRef] [PubMed]

57. Nunes ML, Pinho AP, Sfoggia A. Cerebral aneurysmal dilatation in an infant with perinatally acquired HIV infectionand HSV encephalitis. Arq Neuropsiquiatr.2001 Mar;59(1):116-8. [CrossRef] [PubMed]

58. Bonkowsky JL, Christenson JC, Nixon GW, Pavia AT. Cerebral aneurysms in achild with acquired immune deficiency syndrome during rapid immune reconstitution. J Child Neurol. 2002 Jun;17(6):457-60. Review. [CrossRef] [PubMed]

59. Martнnez-Longoria CA, Morales-Aguirre JJ, Villalobos-Acosta CP, Gуmez-Barreto D, Cashat-Cruz M. Occurrence of intracerebral aneurysm in an HIV-infected child: a case report. Pediatr Neurol. 2004 Aug;31(2):130-2. [CrossRef] [PubMed]

60. Bakhaidar MG, Ahamed NA, Almekhlafi MA, Baeesa SS. De Novo intracerebral aneurysm in a child with acquired immunodeficiency syndrome. Neurosciences (Riyadh). 2015 Jul;20(3):285-91. [CrossRef] [PubMed]

61. Kossorotoff M, Touzй E, Godon-Hardy S, Serre I, Mateus C, Mas JL, Zuber M. Cerebral vasculopathy with aneurysm formation in HIV-infected young adults. Neurology. 2006 Apr 11;66(7):1121-2. [CrossRef] [PubMed]

62. Hamilton DK, Kassell NF, Jensen ME, Dumont AS. Subarachnoid hemorrhage and diffuse vasculopathy in an adult infected with HIV. Case report. J Neurosurg. 2007 Mar;106(3):478-80. [CrossRef] [PubMed]

63. Ake JA, Erickson JC, Lowry KJ. Cerebral aneurysmal arteriopathy associated with HIV infection in an adult. Clin Infect Dis. 2006 Sep 1;43(5):e46-50. [CrossRef] [PubMed]

64. Pagiola IC, Paiva AL, de Aguiar GB, de Oliveira AC, Conti ML, Gagliardi RJ. Cerebral aneurysms associated with human immunodeficiency virus in adults: literature review and new perspectives. Rev Assoc Med Bras (1992). 2016 Jan-Feb;62(1):85-9. Review. [CrossRef] [PubMed]

65. Lahoti AM, Taori AK, Dhok AP, Rawat JS, Chandak NU. Intracranial Aneurysms Involving Circle of Willis in a Child with Human Immunodeficiency Virus Associated Vasculitis- A Rare Case Report. J Clin Diagn Res. 2017Jul;11(7):TD13-TD15. [CrossRef] [PubMed] [PubMed Central]

66. Jordan LC, Johnston SC, Wu YW, Sidney S, Fullerton HJ. The importance of cerebral aneurysms in childhood hemorrhagic stroke: a population-based study. Stroke. 2009 Feb;40(2):400-5. [CrossRef] [PubMed] [PubMed Central]

67. Aeron G, Abruzzo TA, Jones BV. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population. Radiographics. 2012 May-Jun;32(3):667-81. [CrossRef] [PubMed]

68. Durand M, Sheehy O, Baril JG, Le Lorier J, Tremblay CL. Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study. J Stroke Cerebrovasc Dis. 2013 Oct;22(7):e34-41. [CrossRef] [PubMed]

69. Gusev EI, Skvortsova VI. Ishemiya golovnogo mozga. Moscow: Meditsina; 2001. Russian.

70. Shah SS, Zimmerman RA, Rorke LB, Vezina LG. Cerebrovascular complications of HIV in children. AJNR Am J Neuroradiol. 1996 Nov-Dec; 17(10):1913-7. [PubMed] Available from: http://www.ajnr.org/content/17/10/1913.long

71. Edwards NJ, Kamel H, Josephson SA. The safety of intravenous thrombolysis for ischemic stroke in patients with pre-existing cerebral aneurysms: a case series and review of the literature. Stroke. 2012 Feb;43(2):412-6. [CrossRef] [PubMed]

72. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Oct;46(10):3020-35. [CrossRef] [PubMed]

73. Pillay B, Ramdial PK, Naidoo DP, Sartorius B, Singh D. Endovascular Therapy for Large Vessel Vasculopathy in HIV-infected Patients. Eur J Vasc Endovasc Surg. 2016 Sep;52(3):343-51. [CrossRef] [PubMed]

74. Delgado Almandoz JE, Crandall BM, Fease JL, Scholz JM, Anderson RE, Kadkhodayan Y, Tubman DE. Successful endovascular treatment of three fusiform cerebral aneurysms with the Pipeline Embolization Device in a patient with dilating HIV vasculopathy. J Neurointerv Surg. 2014 Mar;6(2):e12. Review. [CrossRef] [PubMed]

75. Padayachy V, Robbs JV. Carotid artery aneurysms in patients with human immunodeficiency virus. J Vasc Surg. 2012 Feb;55(2):331-7. [CrossRef] [PubMed]

76. Maniker AH, Hunt CD. Cerebral aneurysm in the HIV patient: a report of six cases. Surg Neurol. 1996 Jul;46(1):49-54. [CrossRef] [PubMed]

77. Savitr Sastri BV, Devi BI, Gangadharan J, Shukla D. Cerebral aneurysmal childhood arteriopathy. Pediatr Neurosurg. 2011;47(3):233-4. [CrossRef] [PubMed]


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