The significance of HIV status in patients with a spontaneous intracerebral hematoma taken for operative intervention in South Africa – A prospective cohort study.

Introduction: Patients diagnosed with a spontaneous intracerebral hematoma commonly have specific co-morbid medical and social risk factors. Materials and methods: A prospective cohort study enrolling 38 HIV-negative and 32 HIV-positive subjects with a spontaneous intracerebral hematoma who underwent operative intervention. SMUREC/M/32/2022: PG.  Results: Significance was demonstrated between age category and HIV result where subjects in the HIV positive cohort were 10-20 years younger than in the HIV negative cohort (p=0.01).  In the HIV positive cohort (n=32), 22/32 (69%) subjects demonstrated Stage II – IV HIV infection (<500 cells/mm2), and 17/32 (53%) subjects were not on HAART. Considering primary hypertension, a clinical trend was demonstrated where in the HIV positive cohort 26/32 (81%) had primary hypertension, while in the HIV negative cohort 28/38 (74%) had primary hypertension (p=0.45). Considering the location of the intracerebral hematoma 46/70 (66%) subjects had a basal ganglia bleed and 24/70 (34%) subjects had a lobar bleed. Considering the basal ganglia bleed location, in the HIV negative group 16/23 (70%), and similarly in the HIV positive group 15/23 (65%), had putaminal bleeds which was the commonest site (p=0.39). In the lobal bleed subset no significance was demonstrated regarding the location of the lobal bleed (p=0.64). Considering the etiology of the intracerebral hematoma in the HIV negative cohort 22/27 (81.5%), and in the HIV positive cohort 23/25 (92%) subjects incurred hypertensive bleeds (p=0.16). Conclusion: In South Africa co-morbid uncontrolled primary hypertension and stage II-IV HIV infection predominated in our HIV positive cohort. Although HIV positive subjects and HIV negative subjects incurred the same etiology and location of disease, they were generally 10-20 years younger.