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

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.