Carotid artery aneurysm in HIV. A review of case reports in literature

Abstract 19 Background : 20 HIV infection may affect cardiovascular system through different physio pathological patterns 21 including viral vasculitis, thrombophilia induction, opportunistic infection, major HIV vasculo- 22 tropic coinfections and secondary effects of antiretroviral therapy. Vessel pathology may 23 manifest as obstructive disease, dissection or aneurysm conditions that may involve major , 24 medium or small vessels, in different arterial branches. 25 Rarely reported in HIV negative patients , aneurysms involving carotid artery have been 26 described for the first time in seropositive patients in 1989. Since then, sporadic case reports 27 and monocentric experiences have been published on the subject until nowadays ; 28 unexpectedly, in some of the cases aneurysms have occurred notwithstanding the efficacy 29 of antiviral treatment in chronic viral suppression and restoration of the immune function. 30 As a potential aetiological cause of stroke, and because a complete understanding of 31 physiopathology in this setting hasn’t been reached, studies are needed, to improve 32 management of patients affected by this highly morbid-high mortality non-AIDS related 33 comorbidity. 34 Aims : in our study we have focused on aneurysm pathology affecting carotid arteries in HIV 35 patients , analysing clinical and surgical presentation, management and outcome, through a 36 review of cases published in literature. The cases retrieved were additionally analysed 37 according to the segment of carotid artery involved (extra cranial or intracranial carotid 38 artery) with regard to anagraphic details, aneurysm type, presentation, treatment and 39 outcome, to analyse potential differences due to the two main different localization of the 40 lesion. 41 Because of the availability in literature of only scattered information on this clinical subject 42 (fragmented in case reports or small monocentric reports), and of the lack of a previously 43 published overview, our work was conceived to fulfil this actual and necessary clinical need. 44 Methods : Medline(www.ncbi.nlm.nih.gov/pubmed) database was reviewed for “carotid artery 45 aneurysm AND HIV OR AIDS OR immunodeficiency. Research was restricted to English 46 language. Only case reports were included. Data on patients age, sex, traditional risk factors, 47 timing from HIV diagnosis, pharmacological details, coinfection (syphilis, HCV HBV), anatomical 48 localization of lesion (intra or extra-cranial), neurological presentation and, when available, 49 details on cerebral imaging findings (such as subarachnoid haemorrhage or cerebral 50 infarction) surgical treatment , surgical outcome and overall mortality were collected and 51 summarised in tables.