Stroke in HIV-1-Infected Children
The clinical incidence of stroke in HIV-1- infected children has been estimated to be 1.3% in a longitudinal study [106] and 2.6% in a retrospective radiological study [107], higher than that in noninfected children [107].
At autopsy, cerebrovascular disease was documented in 25% of children, confirming that, as in adults, most strokes in children are asymptomatic [106]. Both ischemic stroke and intracerebral hemorrhages have been described, and the reported mechanisms are similar to those reported in adults [9,106,107]. Strokes are principally associated with severe immunodepression and with vertically acquired HIV-1 infection or exposure to the virus in the neonatal period [106]. Cerebrovascular accident may be the initial presentation of HIV-1 infection [108]. Aneurysmal dilatation is more frequently observed in children than in adults, and infection of the parenchymal and leptomeningeal vessels by HIV-1 itself is one of the proposed mechanisms [109]. The presence of the gp41 transmembrane protein in the walls of aneurysms of the circle of Willis found by some investigators [106, 110], although not found by others [111], supports this hypothesis. Independently of exposure to antiretroviral therapy, the carotid arterial wall was also stiffer in HIV-infected children than in control subjects of the same age, but without concomitant increase of the intimamedia thickness [112]. These results are of importance because antiretroviral therapy could counterbalance this possible HIV- induced vascular pathology [113]. Recently, increased carotid intima-media thickness has been reported in antiretroviral therapy-treated children by comparison to matched uninfected controls, suggesting that HIV infected children receiving combined therapies may be at increased risk for premature atherosclerosis [114]. Hyperhomocysteinemia has been observed in HIV-1-infected children on antiretroviral therapy, particularly when PIs are used [115]. Whether these children have an increased risk of premature stroke still remains unknown.
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- Stroke in HIV-1-Infected Children
- Agrawal M.. Textbook of Pediatrics. 3rd ed. — CBS Publishers,2025. — 973 p., 2025
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