Stroke in the HIV Population: Immunologic Mechanisms, Clinical Patterns, and Neuroimaging Approaches: Review Article

Background: With the advent of combination antiretroviral therapy (cART), the survival of people living with HIV (PLWH) has improved substantially. However, cerebrovascular disease has emerged as a major non-AIDS-related comorbidity. Mounting evidence implicates immune suppression, inflammation, and vascular dysfunction in the elevated stroke risk observed among this population. Objective: To explore the relationship between HIV infection, particularly CD4 count levels, and the risk, presentation, and radiological diagnosis of cerebrovascular disease in PLWH. Methods: A comprehensive literature review was conducted through PubMed, Scopus, and Web of Science databases up to May 2025. Search terms included “HIV,” “stroke,” “CD4 count,” “cerebrovascular disease,” and “CT imaging.” Eligible studies included peer-reviewed original research, systematic reviews, and relevant clinical guidelines. Emphasis was placed on the diagnostic utility of neuroimaging and the impact of immunologic status on cerebrovascular outcomes. Conclusion: HIV-related cerebrovascular disease is multifactorial, with low CD4 counts serving as both a risk marker and a predictor of atypical stroke presentations. Neuroimaging, particularly non-contrast and contrast-enhanced computed tomography (CT), is critical for timely diagnosis and treatment planning. Integrating immunologic markers with imaging findings may improve risk stratification and outcomes in PLWH. Further research is needed to refine preventive and therapeutic approaches tailored to this population.