สาขาวิชาโรคติดเชื้อ ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์

The combined antiretroviral therapy (cART) and comprehensive care have prolonged lifespan of persons living with human immunodeficiency virus (HIV). Several diseases associated with aging including cardiovascular diseases, chronic kidney diseases, chronic liver diseases and malignancies have emerged as important comorbidities in this population. Stroke is one of the aging cerebrovascular diseases that may occur coincidentally with or occur as a result of HIV infection. Direct mechanisms of HIV-related stroke include chronic inflammation-associated atherosclerosis, hypercoagulability and vasculopathy while indirect mechanisms are HIV-related opportunistic infections, cART-related adverse reactions and cardioembolism. Presentations of stroke in persons with and without HIV infection are generally similar; however, data for stroke management in HIV-infected population are currently limited. Stroke management and prevention should include identification and treatment of the specific etiology of stroke and relevant risk factors along with cART. Here, the epidemiology, pathogenesis, risk factors, clinical presentations, and management of HIV-associated stroke are reviewed. (J Thai Stroke Soc 2015; 14 (3): 135-145.)