Human immunodeficiency virus (HIV) and stroke: targets for intervention.
Human immunodeficiency virus (HIV) and stroke: targets for intervention.
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人类免疫缺陷病毒（HIV）和中风：干预目标。
DOI：
10.2174/187152610790963483
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
M. Connor
中科院分区：
文献类型：
--
作者：
M. Connor
人类免疫缺陷病毒（HIV）感染通过几种机制引起中风。卒中由机会性感染和肿瘤形成、HIV诱导的心脏病、HIV相关的脑血管病以及可能由HIV诱导的某些形式的系统性血管炎和血栓前血液病的易化引起。艾滋病毒引起的缺血性中风多于脑出血。虽然中风目前是HIV感染的一种相对罕见的表现，但在目前的联合抗逆转录病毒治疗下，HIV感染者中风的发病率可能会增加。HIV感染本身可诱导内皮细胞活化和血脂异常，从而加速动脉粥样硬化。抗逆转录病毒治疗增加了预期寿命，因此随着年龄的增长和暴露于传统危险因素的时间的延长，固有地增加了缺血性卒中的风险，也导致了促动脉粥样硬化代谢和内皮功能障碍。抗逆转录病毒药物诱导的血管功能障碍以及预先存在的HIV诱导的血管疾病有可能增加缺血性卒中的动脉粥样硬化原因。新的抗逆转录病毒药物应该理想地根除人类免疫缺陷病毒，从而降低血管风险和HIV相关的中风原因，而不诱导代谢或内皮功能障碍。未来对HIV感染者血管疾病的研究，特别是研究当前和未来抗逆转录病毒药物的影响的研究，应该理想地评估卒中作为一个特定的结局，并提供病理性卒中类型和缺血性卒中亚型的数据，以阐明卒中的机制并指导治疗和预防卒中的方法。
Human immunodeficiency virus (HIV) infection causes stroke through several mechanisms. Stroke results from opportunistic infection and neoplasia, HIV induced cardiac disease, HIV associated cerebral vasculopathy, and perhaps of HIV induced facilitation of some forms of systemic vasculitis and prothrombotic haematological conditions. HIV causes more ischaemic stroke than cerebral haemorrhage. Although stroke is currently a relatively infrequent manifestation of HIV infection, the incidence of stroke in HIV infected individuals is likely to increase with current combination antiretroviral therapy. HIV infection per se induces endothelial activation and dyslipidaemia, predisposing to accelerated atherosclerosis. Antiretroviral therapy, which increases life expectancy and therefore inherently increases ischaemic stroke risk with advancing age and length of exposure to traditional risk factors, also causes pro-atherosclerotic metabolic and endothelial dysfunction. Antiretroviral induced vascular dysfunction together with pre-existing HIV induced vascular disease has the potential to increase atherosclerotic causes of ischaemic stroke. New antiretroviral agents should ideally eradicate the human immunodeficiency virus thereby reducing vascular risk and HIV related causes of stroke without inducing metabolic or endothelial dysfunction. Future studies of vascular disease in HIV infected individuals, particularly studies investigating the impact of current and future antiretroviral agents, should ideally assess stroke as a specific outcome, and provide data by pathological stroke type and ischaemic stroke subtype, to clarify the mechanisms of stroke and guide the approach to treatment and prevention of stroke.