HIV/AIDS Patients with HIV Vasculopathy and VZV Vasculitis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Stroke is a rising cause of mortality in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) populations. The etiology of stroke remains at the core of the decision-making process to treat and prevent recurrent events. In this population HIV vasculopathy (HIV-V) and varicella zoster virus (VZV) vasculitis are elusive causes of stroke. This study investigated radiological markers that could help identify possible etiological causes.
A series of nine consecutive patients seen at a large metropolitan hospital who presented with AIDS and stroke with the suspicion of either HIV vasculopathy (HIV-V) or VZV vasculitis (VZV-V) were included. A standardized diagnostic approach was used to for HIV-V and VZV-V. Data on frequencies and typical images are reported.
Of the nine patients five had VZV-V and four had HIV-V. Patients with VZV-V were generally younger than those with HIV-V; however, no other significant demographic or cardiovascular differences were found. Of the five patients with VZV-V four had small, deep, subcortical ischemic strokes and only one in this group had a large, cortical, hemispheric stroke but in the HIV-V group three patients had large, cortical hemispheric strokes and only one patient had small, subcortical ischemic strokes.
In this series VZV-V seemed to present more often with deep-seated ischemic infarcts, while HIV-V appeared to be associated with large, hemispheric stroke. It seems plausible that this difference is related to the type of arteries infected by each virus. These findings are preliminary and should be confirmed with better studies.
- Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60. CrossRef
- Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34. doi:10.1097/01.qai.0000233310.90484.16. CrossRef
- Friis-Moller N, Reiss P, Sabin CA, Weber R, Monforte A, El-Sadr W, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356(17):1723–35. CrossRef
- Friis-Moller N, Sabin CA, Weber R, d’Arminio Monforte A, El-Sadr WM, Reiss P, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349(21):1993–2003. CrossRef
- Obel N, Thomsen HF, Kronborg G, Larsen CS, Hildebrandt PR, Sorensen HT, et al. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44(12):1625–31. CrossRef
- Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med. 2006;145(6):397–406.
- Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92(7):2506–12. CrossRef
- Ortiz G, Koch S, Romano JG, Forteza AM, Rabinstein AA. Mechanisms of ischemic stroke in HIV-infected patients. Neurology. 2007;68(16):1257–61. doi:68/16/1257 [pii] 10.1212/01.wnl.0000259515.45579.1e. CrossRef
- 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;62(4):475–95. doi:10.3171/jns.1985.62.4.0475.
- Mizusawa H, Hirano A, Llena JF, Shintaku M. Cerebrovascular lesions in acquired immune deficiency syndrome (AIDS). Acta Neuropathol. 1988;76(5):451–7. CrossRef
- Engstrom JW, Lowenstein DH, Bredesen DE. Cerebral infarctions and transient neurologic deficits associated with acquired immunodeficiency syndrome. Am J Med. 1989;86(5):528–32. CrossRef
- Chetty R, Batitang S, Nair R. Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol. 2000;31(3):374–9. CrossRef
- Dubrovsky T, Curless R, Scott G, Chaneles M, Post MJ, Altman N, et al. Cerebral aneurysmal arteriopathy in childhood AIDS. Neurology. 1998;51(2):560–5.
- Gillams AR, Allen E, Hrieb K, Venna N, Craven D, Carter AP. Cerebral infarction in patients with AIDS. AJNR Am J Neuroradiol. 1997;18(8):1581–5.
- Connor MD, Lammie GA, Bell JE, Warlow CP, Simmonds P, Brettle RD. Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV autopsy cohort. Stroke. 2000;31(9):2117–26. CrossRef
- Tipping B, Villiers L de, Wainwright H, Candy S, Bryer A. Stroke in patients with human immunodeficiency virus infection. J Neurol Neurosurg Psychiatry. 2007;78(12):1320–4. doi:jnnp.2007.116103 [pii] 10.1136/jnnp.2007.116103. CrossRef
- Tipping B, Villiers L de, Candy S, Wainwright H. Stroke caused by human immunodeficiency virus-associated intracranial large-vessel aneurysmal vasculopathy. Arch Neurol. 2006;63(11):1640–2. doi:63/11/1640 [pii] 10.1001/archneur.63.11.1640. CrossRef
- Goldstein DA, Timpone J, Cupps TR. HIV-associated intracranial aneurysmal vasculopathy in adults. J Rheumatol. 2010;37(2):226–33. doi:jrheum.090643 [pii] 10.3899/jrheum.090643. CrossRef
- Gray F, Belec L, Lescs MC, Chretien F, Ciardi A, Hassine D, et al. Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome. Brain. 1994;117(Pt 5):987–99. CrossRef
- Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, et al. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008;70(11):853–60. doi:70/11/853 [pii] 10.1212/01.wnl.0000304747.38502.e8. CrossRef
- Newsome SD, Nath A. Varicella-zoster virus vasculopathy and central nervous system immune reconstitution inflammatory syndrome with human immunodeficiency virus infection treated with steroids. J Neurovirol. 2009:1–4. doi:911196718 [pii] 10.1080/13550280902913610.
- Eugenin EA, Morgello S, Klotman ME, Mosoian A, Lento PA, Berman JW, et al. Human immunodeficiency virus (HIV) infects human arterial smooth muscle cells in vivo and in vitro: implications for the pathogenesis of HIV-mediated vascular disease. Am J Pathol. 2008;172(4):1100–11. doi:ajpath.2008.070457 [pii] 10.2353/ajpath.2008.070457. CrossRef
- Amlie-Lefond C, Kleinschmidt-DeMasters BK, Mahalingam R, Davis LE, Gilden DH. The vasculopathy of varicella-zoster virus encephalitis. Ann Neurol. 1995;37(6):784–90. doi:10.1002/ana.410370612. CrossRef
- Berkefeld J, Enzensberger W, Lanfermann H. MRI in human immunodeficiency virus-associated cerebral vasculitis. Neuroradiology. 2000;42(7):526–8. CrossRef
- Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, et al. The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology. 2007;68(13):1069–73. doi:01.wnl.0000258549.13334.16 [pii] 10.1212/01.wnl.0000258549.13334.16. CrossRef
- Ortiz GA, Koch S, Forteza A, Romano J. Ramsay Hunt syndrome followed by multifocal vasculopathy and posterior circulation strokes. Neurology. 2008;70(13):1049–51. doi:70/13/1049 [pii] 10.1212/01.wnl.0000306634.51885.87. CrossRef
- Hovens MM, Vaessen N, Sijpkens YW, Fijter JW de. Unusual presentation of central nervous system manifestations of Varicella zoster virus vasculopathy in renal transplant recipients. Transpl Infect Dis. 2007;9(3):237–40. doi:TID190 [pii] 10.1111/j.1399–3062.2006.00190.x. CrossRef
- Saraya T, Shimura C, Wada H, Aoshima M, Goto H. Evidence for vascular spread of varicella zoster-associated vasculopathy. Ann Intern Med. 2006;144(7):535–7. doi:144/7/535-a [pii].
- Broucker T de, Verollet D, Schoindre Y, Henry C, Martinez-Almoyna L, Tourret J, et al. Cerebral vasculitis with aneurysms caused by varicella-zoster virus infection during AIDS: a new clinicoangiographical syndrome. Rev Neurol (Paris). 2008;164(1):61–71. doi:S0035–3787(07)00018–5 [pii] 10.1016/j.neurol.2007.07.004.
- Kossorotoff M, Touze E, Godon-Hardy S, Serre I, Mateus C, Mas JL, et al. Cerebral vasculopathy with aneurysm formation in HIV-infected young adults. Neurology. 2006;66(7):1121–2. doi:66/7/1121 [pii] 10.1212/01.wnl.0000204188.85402.0c. CrossRef
- Petito CK, Cash KS. Blood-brain barrier abnormalities in the acquired immunodeficiency syndrome: immunohistochemical localization of serum proteins in postmortem brain. Ann Neurol. 1992;32(5):658–66. doi:10.1002/ana.410320509. CrossRef
- Toschi E, Barillari G, Sgadari C, Bacigalupo I, Cereseto A, Carlei D, et al. Activation of matrix-metalloproteinase-2 and membrane-type-1-matrix-metalloproteinase in endothelial cells and induction of vascular permeability in vivo by human immunodeficiency virus-1 Tat protein and basic fibroblast growth factor. Mol Biol Cell. 2001;12(10):2934–46.
- Falangola MF, Hanly A, Galvao-Castro B, Petito CK. HIV infection of human choroid plexus: a possible mechanism of viral entry into the CNS. J Neuropathol Exp Neurol. 1995;54(4):497–503. CrossRef
- Gutierrez J, Sacco RL, Wright CB. Dolichoectasia—an evolving arterial disease. Nat Rev Neurol. 2011;7(1):41–50. doi:nrneurol.2010.181 [pii] 10.1038/nrneurol.2010.181. CrossRef
- Volker W, Dittrich R, Grewe S, Nassenstein I, Csiba L, Herczeg L, et al. The outer arterial wall layers are primarily affected in spontaneous cervical artery dissection. Neurology. 2011;76(17):1463–71. doi:WNL.0b013e318217e71c [pii] 10.1212/WNL.0b013e318217e71c. CrossRef
- Mas JL, Bousser MG, Hasboun D, Laplane D. Extracranial vertebral artery dissections: a review of 13 cases. Stroke. 1987;18(6):1037–47. CrossRef
- Nagel MA, Mahalingam R, Cohrs RJ, Gilden D. Virus vasculopathy and stroke: an under-recognized cause and treatment target. Infect Disord Drug Targets. 2010;10(2):105–11. doi:BSP/ID-DT/E-Pub/0015-10-2 [pii].
- Borota L, Jonasson P. Basilar and bilateral carotid dolichoectasia with spontaneous dissection of C2 segment of the internal carotid artery. AJNR Am J Neuroradiol. 2006;27(6):1241–4. doi:27/6/1241 [pii].
- Mizutani T, Miki Y, Kojima H, Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery. 1999;45(2):253–9; discussion 9–60. CrossRef
- HIV/AIDS Patients with HIV Vasculopathy and VZV Vasculitis
Volume 21, Issue 3 , pp 145-151
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Human immunodeficiency virus
- Varicella zoster virus
- Magnetic resonance imaging
- Industry Sectors
- Author Affiliations
- 1. Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 33136, Miami, FL, USA
- 2. Department of Epidemiology and Biostatistics, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA