Computed tomography findings of cerebrovascular disease in HIV-positive patients: Incidence and associated risk factors

Background: In 2023, an estimated 39.9 million people worldwide were living with HIV, with 30.7 million on antiretroviral therapy (ART). As life expectancy among people living with HIV improves, non-infectious complications such as cerebrovascular disease have emerged as key contributors to morbidity and mortality. Stroke in PLWH is influenced by inflammation, endothelial dysfunction, coagulation abnormalities, and opportunistic infections, often compounded by traditional vascular risk factors and ART-associated metabolic changes. While computed tomography (CT) is widely used to detect cerebrovascular abnormalities, data remains limited on CT patterns and their associations with HIV-specific and traditional risk factors in resource-limited settings. Methods: This cross-sectional study included 80 adult HIV-positive patients admitted to Mbabane National Hospital between February 2024 and February 2025. Comprehensive clinical evaluation, laboratory investigations (including viral load, CD4 count, metabolic and inflammatory markers), and CT brain imaging were performed. CT findings were categorized as positive or negative, with positive scans further classified into ischemic stroke, intracerebral hemorrhage, and other abnormalities. Associations between cerebrovascular findings and clinical variables were analyzed using correlation statistics. Results: Of the 80 participants (mean age 35.5 ± 9.0 years; 67.5% male), 81.3% (n = 65) demonstrated cerebrovascular abnormalities on CT, most commonly ischemic stroke (37.5%), followed by intracerebral hemorrhage (10.0%). Mean NIHSS score was 8.7 ± 5.1. Cerebrovascular findings showed a negative correlation with ART status (r = -0.305, p = 0.045), and positive correlations with hyperlipidemia (r = 0.624, p < 0.001), smoking (r = 0.489, p = 0.007), obesity (r = 0.511, p = 0.004), family history of stroke (r = 0.432, p = 0.025), and viral load (r = 0.596, p = 0.001). Conclusion: Cerebrovascular abnormalities were highly prevalent among HIV-positive adults in this setting, particularly ischemic strokes. Key risk factors included uncontrolled HIV (high viral load), absence of ART, and traditional comorbidities. These findings highlight the importance of comprehensive stroke prevention strategies in PLWH that combine effective HIV management with targeted control of modifiable vascular risk factors.