Human Immunodeficiency Virus–Associated Cerebral Aneurysmal Vasculopathy: A Systematic Review

• Published in: World neurosurgery Vol. 87; pp. 220 - 229
• Main Authors: Baeesa, Saleh S, Bakhaidar, Mohamad, Almekhlafi, Mohammed A, Madani, Tariq A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Adult; Antiretroviral Therapy, Highly Active; Cerebral aneurysm; Child; HIV Infections - complications; HIV Infections - mortality; HIV-associated cerebral vasculopathy; Human immunodeficiency virus; Humans; Intracranial Aneurysm - etiology; Intracranial Aneurysm - mortality; Intracranial Aneurysm - pathology; Middle Cerebral Artery - pathology; Neurosurgery; Subarachnoid hemorrhage; Cerebral aneurysm; ART; Subarachnoid hemorrhage; HIV-associated cerebral vasculopathy; Anterior cerebral artery; Antiretroviral therapy; Highly active antiretroviral therapy; VZV; HIV; Human immunodeficiency virus; SAH; Varicella-zoster virus; ACA; HAART
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.11.023

Background Human immunodeficiency virus (HIV)–associated cerebral aneurysmal vasculopathy is a rare complication of HIV affecting pediatric and adult patients and has been the subject of many case reports and case series. Methods We performed a systematic literature search of PubMed, EMBASE, Scopus, Web of Science, Science Direct, and Google Scholar up to April 10, 2015. Our inclusion criteria encompassed all reported original case series and reports of HIV-associated cerebral aneurysms diagnosed radiologically. We analyzed the clinical characteristics and management of the reported cases. Results We identified 61 patients reported in the literature (45 pediatric and 16 adult patients). The median age was 9.8 years for pediatric patients and 36.5 years for adult patients. Weakness was the most common presenting symptom in adult and pediatric patients. The most common affected artery was the middle cerebral artery. Approximately 87.2% of pediatric patients and 42.9% of adult patients were on antiretroviral therapy (ART) at presentation. The mortality rate was 60% and 35.7% among pediatric and adult patients, respectively. The optimal management is not well established. Variable response to ART was reported with possible survival benefits when ART was initiated early. Conclusions HIV-associated cerebral aneurysmal arteriopathy is associated with high mortality. The optimal management is not well established, but early initiation of ART may improve the survival rate.