Intracranial Meningiomas in the Era of HIV and Antiretroviral Therapies

Abstract

Introduction: Development of neoplasm among HIV- infected individuals has always been attributable to failure of immune surveillance and co-infection with opportunistic oncogenic viruses. HIV-1 was regarded as non-transforming retrovirus lacking viral oncogenic potential. We hypothesise that HIV-1 infection predisposes to the development of histologically high-grade intracranial meningiomas, in the earlier decades of life than previously reported. Method: Data was collected and captured in an Excel spreadsheet (Microsoft, Redmond, Washington) and exported to Inter- national Business Machine, Statistical Package for the Social Sciences (IBM SSPS, Armonk, New York) version 24 for data cleansing and analysis. A P-value < .05 was considered as statistically significant. Quantitative variables were described using median and interquartile range. Categorical variables were described using frequency (percentage), tables, and proportions. Comparison was made between the groups using nonparametric Kruskul–Wallis test or Pearson’s chi square where appropriate. Multiple logistic regression analysis was used to assess associations between the risk factors and WHO grades whilst adjusting for confounders. Odds ratios (OR) and 95% confidence intervals (CI) were presented. Results: A total of 399 patients were identified, and 12 patients were excluded due to inadequate information. There were 63 (16.3%) HIV-1 seropositive, 134 (34.6%) confirmed HIV-1 negative, and 190 (49%) patients with unknown HIV status. This included 83 (21.4%) males and 304 (78.6%) females, M:F = 1:3.7. Overall median age was 47 yr (interquartile range [IQR] = 39-57 yr). Median age of HIV-1-seropositive patients was 38 yr (IQR = 32-45 yr), for HIV negative was 47 yr (IQR = 41-59 yr), and for unknown HIV status group was 48.5 yr (IQR 42-59 yr), P < .001. HIV-1-seropositive patients had 5-fold increased risk of devel- oping high-grade meningiomas (WHO grade II/III), P < .001, OR = 5.05 (95% CI 2.53-10.07), after adjusting for age, gender, and CD4+ count. HIV-1-seropositive patients had 4- fold increased risk of harboring atypical meningioma (38.1% vs 16.4%), P < .001, OR = 4.02 (95% CI 1.95-8.32). HIV-1- seropositive patients also had 30-fold increased risk of developing anaplastic meningiomas compared to their HIV-negative counter- parts (11.1% vs 0.7%), P < .001, OR = 30.81 (95% CI 3.41- 278.76; Table 2). Conclusion: HIV 1 infection is associated with the development of Intracranial meningiomas at the younger age 30-40 years that seen I HIV negative patients and is is associated with high propensity for WHO grade II and Grade III meningiomas.