The management outcomes of chronic subdural hematoma in HIV-Infected individuals.

Abstract

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.