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2015 ; 26
(2
): 70-81
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HIV-associated large-vessel vasculopathy: a review of the current and emerging
clinicopathological spectrum in vascular surgical practice
#MMPMID25940120
Pillay B
; Ramdial PK
; Naidoo DP
Cardiovasc J Afr
2015[Mar]; 26
(2
): 70-81
PMID25940120
show ga
An established relationship exists between human immunodeficiency virus (HIV) and
the vascular system, which is characterised by clinical expressions of aneurysmal
and occlusive disease that emanate from a common pathological process. The exact
pathogenesis is currently unknown; attempts to implicate opportunistic pathogens
have been futile. Theories converge on leucocytoclastic vasculitis with the vaso
vasora as the vasculopathic epicentre. It is thought that the virus itself or
viral proteins trigger the release of inflammatory mediators that cause
endothelial dysfunction and smooth muscle proliferation leading to vascular
injury and thrombosis. The beneficial effects of highly active anti-retroviral
therapy alter the natural history of the disease profile and promote longevity
but are negated by cardiovascular complications. Atherosclerosis is an emerging
challenge. Presently patients are managed by standard surgical protocols because
of non-existent universal surgical interventional guidelines. Clinical response
to treatment is variable and often compounded by complications of graft
occlusion, sepsis and poor wound healing. The clinical, imaging and pathological
observations position HIV-associated large-vessel vasculopathy as a unique
entity. This review highlights the spectrum of HIV-associated large-vessel
aneurysmal, occlusive and atherosclerotic disease in vascular surgical practice.