Abstract
BackgroundHydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)-related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). In HIV-infected patients there is concern that VPS might be associated with unacceptably high mortality. To identify prognostic indicators, we aimed to compare survival and clinical outcome following VPS placement between all studied causes of hydrocephalus in HIV infected patients.MethodsThe following electronic databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE, CINAHL Plus, LILACS, Research Registry, the metaRegister of Controlled Trials, ClinicalTrials.gov, African Journals Online, and the OpenGrey database. We included observational studies of HIV-infected patients treated with VPS which reported of survival or clinical outcome. Data was extracted using standardised proformas. Risk of bias was assessed using validated domain-based tools.ResultsSeven Hunderd twenty-three unique study records were screened. Nine observational studies were included. Three included a total of 75 patients with tuberculous meningitis (TBM) and six included a total of 49 patients with cryptococcal meningitis (CM). All of the CM and two of the TBM studies were of weak quality. One of the TBM studies was of moderate quality. One-month mortality ranged from 62.5–100% for CM and 33.3–61.9% for TBM. These pooled data were of low to very-low quality and was inadequate to support meta-analysis between aetiologies. Pooling of results from two studies with a total of 77 participants indicated that HIV-infected patients with TBM had higher risk of one-month mortality compared with HIV non-infected controls (odds ratio 3.03; 95% confidence-interval 1.13–8.12; p = 0.03).ConclusionsThe evidence base is currently inadequate to inform prognostication in VPS insertion in HIV-infected patients. A population-based prospective cohort study is required to address this, in the first instance.
Highlights
Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS)
No further studies were identified by expert opinion. 624 records were excluded by title and abstract screening. 33 records were selected for full text review [8, 20, 44,45,46, 53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78]
Three studies included a total of 75 patients with tuberculous meningitis (TBM) [44, 46, 79] and six included a total of 49 patients with cryptococcal meningitis (CM) [45, 53, 72,73,74,75]
Summary
Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). Age-related cerebral tissue loss as well as HIV associated neurocognitive disorder are associated with enlargement of CSF spaces due to generalised brain atrophy and may result in the radiological appearance of hydrocephalus, but are associated with normal CSF pressure and flow, so called “hydrocephalus ex vacuo” [10, 11]. This is not an indication for surgical treatment and, is not discussed in this study [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
