Chronic Subdural Haematoma In HIV-Positive Patients: Is There A Difference In The Clinical Presentation?

Résumé

Background: Chronic subdural haematoma (CSDH) predominantly affects the elderly and is uncommon in young patients. The pathogenesis involves an interplay between inflammation, disorganised coagulation, fibrinolysis and angiogenesis. Human Immunodeficiency Virus (HIV) infection is a proposed link between inflammation, immune activation and endothelial dysfunction in CSDH through its Tat, gp120, and Nef proteins. The purpose of this study was to describe the clinical characteristics and management outcomes of CSDH in HIV-infected patients. Methods: This retrospective chart review included all HIV-positive adults treated for CSDH at the Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital between January 2006 and December 2020. We analysed patient demographics, CD4+ count, viral load, coagulation profile, access to anti-retroviral therapy (ART), neuro-imaging, management and outcomes. Patients with a history of trauma were excluded. Results: Seventy-nine patients met inclusion criteria, the majority [45; 57%] were female. The mean age= 38.7 years (±13.65), [age 0-18 (6,7.6%), 19-30 (13,16.5%), 30-45 (34,43%), 45-55 (19,24%) and > 55 (8,10%)]. Mean CD4+ count= 280 cell/uL, and mean platelets = 287.26 (±161.14). 60% patients were on ART. Septic complications were reported in 21(26.58%).  The mortality rate was 10.13%. Conclusion: Age at presentation of CSDH is younger in HIV-positive patients. It was more common in females representing a gender reversal when compared to the literature but is in line with the prevalence of HIV in the female population in South Africa. Further studies are warranted to assess the role of HIV proteins in pathological angiogenesis causing CSDH in the HIV-positive population.