Abstract
BackgroundHydrocephalus is a recognised complication of human immunodeficiency virus (HIV)-related opportunistic infections. Symptomatic raised cerebrospinal fluid pressure can be treated with ventriculoperitoneal shunt insertion (VPS). In HIV-infected patients however, there is a concern that VPS might be associated with unacceptably high rates of mortality. We aim to systematically review and appraise published literature to determine reported outcomes and identify predictors of outcome following VPS in relevant subgroups of HIV-infected adults.MethodsThe following electronic databases will be searched: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), LILACS (BIREME), Research Registry (www.researchregistry.com), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and OpenSIGLE database. Any randomised studies, cohort studies, case-control studies, interrupted time series or sequential case series reporting survival following VPS in HIV-infected individuals will be included. If high-quality homogenous studies exist, meta-analysis will be conducted to determine 1-, 6- and 12-month mortality with comparison made between underlying aetiologies of hydrocephalus.Discussion and conclusionThis study will generate a comprehensive review of VPS in HIV-infected patients for publication. The primary outcome of meta-analysis is 12-month survival. If only low-quality, heterogeneous studies are available, this study will demonstrate this deficiency and will be of value in justifying and aiding the design of future studies.Systematic review registrationPROSPERO CRD42016052239
Highlights
Hydrocephalus is a recognised complication of human immunodeficiency virus (HIV)-related opportunistic infections
Our objectives were to compare post-ventriculoperitoneal shunt insertion (VPS) mortality, VPS infection, VPS malfunction and clinical outcome and rates of other complications at 1, 6 and 12 months between different aetiologies of HIV-associated hydrocephalus using quantitative meta-analysis and production of a narrative review. They would allow the identification of baseline patient characteristics which are predictive of good outcome following VPS in HIV infection
It is believed that the neurosurgical management of central nervous system (CNS) complications of HIV infection has received relatively little research attention, and guidelines for management to date have been based on low-quality evidence [58, 59]
Summary
Hydrocephalus is a recognised complication of human immunodeficiency virus (HIV)-related opportunistic infections. HIV infection is associated with myriad central nervous system (CNS) sequelae These include, but are not limited to, toxoplasmosis, primary CNS lymphoma (PCNSL), tuberculous meningitis (TBM), cryptococcal meningitis and immune reconstitution inflammatory syndrome (IRIS) [5,6,7,8]. These may all disrupt cerebrospinal fluid (CSF) circulation causing an abnormal accumulation of CSF within the cranium, an associated rise in intracranial pressure and consequent cerebral injury.
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