Evaluating the significance of HIV status in patients with neoplastic brain tumors admitted to a single neurosurgical center in South Africa – A prospective cohort study

Abstract

IntroductionWhile global awareness of HIV disease has grown exponentially due to public awareness initiatives, the specifics of the impact of being HIV positive in patients presenting with brain tumours is lacking. Materials and methodsWe conducted a prospective cohort study consecutively enrolling all subjects with a neoplastic brain tumour from the 01 July 2018–31 March 2020. The data collected in this study included age, gender, HIV status, admission absolute CD4 count, radiological diagnosis, blood loss, length of surgery, extent of resection, histological diagnosis, nosocomial infection incidence, and Glasgow Outcome Score. ResultsIn total 101 subjects were enrolled in the study which comprised 65/101 (64%) HIV negative subjects and 36/101 (36%) HIV positive subjects. In terms of HIV result and admission absolute CD4 count, significance was demonstrated (p < 0.001). Considering radiological tumour diagnosis and HIV result a significant relationship was demonstrated, favouring meningiomas and pituitary tumours in the HIV negative cohort, and high-grade glioma and metastasis in the HIV positive cohort (p = 0.04). Of the 101 subjects enrolled in the study, 78 were taken for operative intervention and of these 50/78 (64%) were HIV negative and 28/78 (36%) were HIV positive. Regarding length of surgery, while no significance was demonstrated (p = 0.72), a clinical trend was suggested that elective brain tumour surgery takes longer in HIV positive patients. With regards extent of resection significance was demonstrated, favouring gross total resection in the HIV negative cohort, and subtotal resection in the HIV positive cohort (p = 0.0025). ConclusionIn our study significance was demonstrated between HIV result and radiological tumour diagnosis. We further demonstrated significance between HIV result and admission CD4 count. According to a PubMed review we are the first to suggest a trend for surgery to take longer in HIV positive patients, as well as report the significance of the extent of resection.