Comparison of cross-sectional imaging in patients presenting with hepatic hydatid disease with and without HIV co-infection

Abstract

Background: Observations from case studies have raised the hypothesis that co-infection of HIV and Echinococcus granulosis (EG) may lead to a more severe clinical presentation of hepatic hydatid disease (HHD). This study assessed this hypothesis by comparing pre-operative cross-sectional imaging in patients with HHD with and without HIV co-infection. Material & Methods: Patients presenting at the Surgical Gastroenterology unit, Groote Schuur Hospital, South Africa with HHD between 2012 and 2018, for whom the HIV status was known and with cross-sectional imaging (CT and/or MRI) available for review, were included. Images for each patient were reviewed by two experienced HPB surgeons in a blinded fashion. Where assessment did not concur, consensus was reached through combined re-assessment. Cyst number, size, location and findings were classified according to the WHO and Gharbi classifications. Results: The study included 16 HIV+ and 16 HIV- patients. Right liver predominance was found in all HIV+ patients, compared to 50% in the HIV- group (p=0.007). Extrahepatic cysts were equally prevalent. There were no significant differences between cyst number, size or multilocularity between the two groups. Radiological suspicion of cyst rupture was found in 3/16 HIV+ and 4/16 HIV- patients (p=0.685). No differences were found in the Gharbi classification or WHO classification types between the two groups. Conclusion: This is the first comparative study on imaging between HIV+ and HIV- HHD patients. A more severe clinical presentation for HIV+ patients, as previously postulated, was not reflected in the comparison as equitable cyst characteristics and type were observed. An unexplained right liver predominance was demonstrated in HIV+ patients.