Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies

doi:10.1212/NXI.0000000000000254

. 2016 Jun 30;3(4):e254.

doi: 10.1212/NXI.0000000000000254. eCollection 2016 Aug.

Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies

Laura A Benjamin¹, Alan Bryer¹, Sebastian Lucas¹, Alan Stanley¹, Theresa J Allain¹, Elizabeth Joekes¹, Hedley Emsley¹, Ian Turnbull¹, Colin Downey¹, Cheng-Hock Toh¹, Kevin Brown¹, David Brown¹, Catherine Ison¹, Colin Smith¹, Elizabeth L Corbett¹, Avindra Nath¹, Robert S Heyderman¹, Myles D Connor¹, Tom Solomon¹

Affiliations

Affiliation

¹ Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK.

PMID: 27386505
PMCID: PMC4929887
DOI: 10.1212/NXI.0000000000000254

Free PMC article

Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies

Laura A Benjamin et al. Neurol Neuroimmunol Neuroinflamm. 2016.

Free PMC article

. 2016 Jun 30;3(4):e254.

doi: 10.1212/NXI.0000000000000254. eCollection 2016 Aug.

Authors

Affiliation

¹ Malawi-Liverpool-Wellcome Trust Clinical Research Programme (L.A.B., E.L.C., R.S.H.) and Department of Medicine (L.A.B., T.J.A.), University of Malawi College of Medicine, Blantyre; Institute of Infection and Global Health (L.A.B., H.E., T.S.), University of Liverpool; Walton Centre NHS Foundation Trust (L.A.B., T.S.), Liverpool, UK; Department of Medicine (A.B., A.S.), Division of Neurology, Groote Schuur Hospital, University of Cape Town, South Africa; Department of Histopathology (S.L.), St. Thomas Hospital, London; Radiology Department (E.J.) and Haematology Department (C.D., C.-H.T.), Royal Liverpool Hospital; Preston Hospital (H.E.); North Manchester General Hospital (I.T.); Virus Reference Department (K.B., D.B.) and Syphilis Reference Department (C.I.), Public Health England, London; Centre for Clinical Brain Sciences (C.S.) and Division of Clinical Neurosciences (M.D.C.), University of Edinburgh; Department of Clinical Research (E.L.C.), London School of Hygiene and Tropical Medicine, UK; National Institutes of Health (A.N.), Bethesda, MD; Division of Infection and Immunity (R.S.H.), University College London; NHS Borders (M.D.C.), Melrose, UK; School of Public Health (M.D.C.), University of the Witwatersrand, South Africa; and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections (T.S.), Liverpool, UK.

PMID: 27386505
PMCID: PMC4929887
DOI: 10.1212/NXI.0000000000000254

Abstract

HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.

Figures

**Figure 1.. An algorithm to define the etiology of HIV-related ischemic stroke for research studies**
Minimum battery of tests include the following: HIV test, full blood count and blood film and urine dipstix assay, anticardiolipin antibodies, lupus anticoagulant, anti–β₂-glycoprotein, hemoglobin for sickle cell disease, serum syphilis treponemal (immunoassay + agglutination test) and nontreponemal tests, chest x-ray, CSF—microscopy, biochemistry, India ink and acid fast bacilli stains, blood culture, tuberculosis culture, unenhanced CT, ECG, and carotid/vertebral duplex ultrasound and echocardiography. APS = antiphospholipid syndrome; OI = opportunistic infection; TTP = thrombotic thrombocytopenic purpura.

**Figure 2.. Different pathologic description of vasculopathy associated with HIV infection**
(A, B) Atherosclerotic vasculopathy. (C) HIV-associated vasculitis. (D, arteriolosclerosis; E, lipohyalinosis) Small vessel disease. (F) Nonatherosclerotic vasculopathy. (A–E) From personal archives. (F) Reproduced with permission from the *Archives of Neurology*. 2006. 63: 1640–1642. Copyright© 2006 American Medical Association. All rights reserved.

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References

1. Hasse B, Ledergerber B, Furrer H, et al. . Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis 2011;53:1130–1139. - PubMed
1. Benjamin LA, Corbett EL, Connor MD, et al. . HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study. Neurology 2016;86:324–333. - PMC - PubMed
1. Thakur KT, Lyons JL, Smith BR, Shinohara RT, Mateen FJ. Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol 2016;22:50–55. - PubMed
1. Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol 2012;11:878–890. - PMC - PubMed
1. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. . Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41. - PubMed

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[1] Hasse B, Ledergerber B, Furrer H, et al. . Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis 2011;53:1130–1139. - PubMed

[2] Hasse B, Ledergerber B, Furrer H, et al. . Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis 2011;53:1130–1139. - PubMed

[3] Benjamin LA, Corbett EL, Connor MD, et al. . HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study. Neurology 2016;86:324–333. - PMC - PubMed

[4] Benjamin LA, Corbett EL, Connor MD, et al. . HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study. Neurology 2016;86:324–333. - PMC - PubMed

[5] Thakur KT, Lyons JL, Smith BR, Shinohara RT, Mateen FJ. Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol 2016;22:50–55. - PubMed

[6] Thakur KT, Lyons JL, Smith BR, Shinohara RT, Mateen FJ. Stroke in HIV-infected African Americans: a retrospective cohort study. J Neurovirol 2016;22:50–55. - PubMed

[7] Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol 2012;11:878–890. - PMC - PubMed

[8] Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol 2012;11:878–890. - PMC - PubMed

[9] Adams HP Jr, Bendixen BH, Kappelle LJ, et al. . Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41. - PubMed

[10] Adams HP Jr, Bendixen BH, Kappelle LJ, et al. . Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41. - PubMed

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Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies

Affiliation

Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies

Authors

Affiliation

Abstract

Figures

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Cited by 14 articles

References

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Abstract

Figures

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Cited by 14 articles

References

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