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The management outcomes of chronic subdural hematoma in HIV-Infected individuals
Kuzolunga Xulu1,2, Nomusa Shezi1,2, Basil Enicker3,4
1Department of Neurosurgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Insights
Chronic subdural hematoma (CSDH) in HIV patients occurs at a younger age. Mortality is linked to low Glasgow Coma Scale (GCS) scores, elevated INR, and septicemia, not CD4 count.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Public Health
Background:
- Chronic subdural hematoma (CSDH) predominantly affects the elderly, carrying significant morbidity and mortality risks.
- Limited data exists on the clinical presentation and outcomes of CSDH specifically in individuals with human immunodeficiency virus (HIV).
Purpose of the Study:
- To delineate the clinical characteristics and management outcomes of CSDH in patients with HIV infection.
- To compare CSDH presentation and outcomes between HIV-infected individuals with different CD4+ T-cell counts.
Main Methods:
- A retrospective review of 48 HIV-infected patients with CSDH from January 2006 to December 2022.
- Patients were categorized based on CD4+ T-cell counts (≥200 vs. <200 cells/µL).
- Analysis included demographics, clinical presentation, anti-retroviral therapy (ART) status, radiological findings, surgical interventions, and outcomes.
Main Results:
- The median age of HIV-infected patients with CSDH was 38 years; 52.1% had CD4 counts ≥200 cells/µL.
- Common symptoms included headaches (47.9%) and hemiparesis (43.8%); 25% had bilateral CSDH.
- Mortality was 14.6%, associated with low Glasgow Coma Scale (GCS), INR > 1.2, and septicemia. Postoperative complications included recurrence (16.7%) and septicemia (10.4%).
Conclusions:
- CSDH in HIV-infected individuals presents at a younger age compared to the general population.
- CD4+ T-cell count was not a predictor of surgical outcomes in this cohort.
- Low GCS, elevated INR, and septicemia were significant predictors of mortality in HIV-infected patients with CSDH.
Background:
Chronic subdural hematoma (CSDH) typically affects the elderly and is associated with significant morbidity and mortality. However, data on its presentation and outcomes in individuals living with HIV are limited. The purpose of the study was to describe the clinical profile and management outcomes of CSDH in HIV-infected patients.
Methods:
A retrospective review was conducted between January 2006 and December 2022. Patients were stratified into two groups based on CD4 count ≥ and < 200 cells/µL. Variables analyzed included demographics, clinical characteristics, anti-retroviral therapy (ART) status, radiological findings, surgical management and outcomes.
Results:
Forty-eight patients were included, with a median age of 38 years. The majority (52.1%) had a CD4 count ≥ 200 cells/µL. Males comprised 50% of the cohort, with a higher proportion of males in the CD4 count ≥ 200 group (p = 0.029). The median admission Glasgow Coma Scale (GCS) was 14. Common clinical presentations included headaches (47.9%) and hemiparesis (43.8%). ART coverage was 58.3%, and bilateral CSDH was diagnosed in 25%. Most patients (72.9%) received two burr holes. Postoperative complications included recurrence (16.7%), septicemia (10.4%), and subdural empyema (2.1%). Mortality rate was 14.6%. Factors significantly associated with mortality included low GCS, INR > 1.2 and septicemia.
Conclusions:
CSDH in HIV-infected individuals presents at a younger age than in the general population. While most patients had CD4 count of ≥ 200 cells/µL, CD4 level was not a predictor of surgical outcome. Mortality was associated with low GCS, increased INR, and septicemia.
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