The Angiographic Appearance of Intracranial Aneurysms in Human Immunodeficiency Virus-Infected Patients at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Background Intracranial aneurysms can cause subarachnoid hemorrhage, which has a high risk of death and serious complications. HIV infection is known to cause problems in blood vessels, including the formation of aneurysms, mainly due to ongoing inflammation and damage to the inner lining of blood vessels (endothelial dysfunction). Although aneurysms related to HIV have been reported in children, there is not much information about adults, especially in places like South Africa, where HIV is very common. It is still unclear how a weakened immune system (measured by CD4 count) or treatment with highly active antiretroviral therapy (HAART) affects the shape and growth of these aneurysms. This study helps to fill that gap by looking at the angiographic features of intracranial aneurysms in people with and without HIV. Aim of the study To investigate the angiographic features of intracranial aneurysms in HIV-infected individuals and compare them with HIV-negative patients, while exploring associations with CD4 count and HAART status. Methodology We conducted a retrospective review by including 137 patients diagnosed with intracranial aneurysms at Charlotte Maxeke Johannesburg Academic Hospital from June 2014 to June 2022. Angiographic data from CTA and DSA were analyzed to assess aneurysm size, shape, and location. Patient records provided HIV status, CD4 count, and HAART therapy information. Aneurysm characteristics were compared between HIV- positive and HIV-negative groups, and statistical tests were used to evaluate associations with CD4 counts and HAART status. Results Among the 137 patients, 36 were HIV-positive and 26 were HIV-negative. No significant differences in aneurysm location or shape were found between the groups. However, a weak but significant negative correlation was observed between CD4 count and aneurysm height (r = -0.348, p = 0.037) and aspect ratio (r = -0.440, p = 0.007), indicating that lower CD4 counts were associated with larger aneurysms. HIV-positive patients on HAART had significantly larger aneurysm dimensions than those not on HAART (neck width p = 0.035, dome width p = 0.013, height p = 0.006), although aspect ratio did not differ significantly. Aneurysm rupture rates and the number of multiple aneurysms did not significantly differ between groups. Conclusion HIV status alone did not significantly alter aneurysm morphology or location; however, advanced immunosuppression (low CD4 count) and HAART therapy were associated with increased aneurysm dimensions. Immune status and antiretroviral treatment may influence aneurysm progression. Routine vascular screening may be warranted for immunosuppressed PLWH, especially those with additional vascular risk factors.