Cerebrovascular disease in HIV-infected adults: Incidence and CT findings in relation to CD4 counts

Background: With the success of combination antiretroviral therapy (cART), the life expectancy of HIV-infected individuals has improved; however, non-AIDS-related comorbidities such as cerebrovascular disease (CVD) have emerged as significant causes of morbidity and mortality. Immunosuppression, persistent inflammation, and HIV-related vascular changes contribute to increased stroke risk. This study aimed to assess the incidence and CT findings of cerebrovascular disease in HIV-infected adults in correlation with CD4+ cell counts in the Kingdom of Eswatini.Methods: A prospective study was conducted on 60 HIV-positive adult patients admitted to Mbabane National Hospital. All participants underwent full clinical evaluation, laboratory investigations including CD4+ count and HIV RNA levels, and non-contrast brain CT scanning to assess cerebrovascular events.Results: This study included 60 HIV-positive patients with a mean age of 35.1 years; 66.7% were male. Most patients (76.7%) were not receiving ART and had significantly lower CD4? counts. Cerebrovascular events were present in 83.3% of patients, predominantly ischemic strokes (38.3%). Higher HIV RNA levels were significantly associated with ischemic and hemorrhagic strokes, while ART use was inversely associated with cerebrovascular events. Traditional risk factors—hyperlipidemia, obesity, smoking, and family history—also showed strong associations. Hematologic parameters correlated positively with CD4? counts and negatively with stroke severity (NIHSS scores). Overall, low CD4? counts and uncontrolled viremia were key contributors to cerebrovascular complications, especially in ART-naïve individuals. Conclusion: Cerebrovascular disease is highly prevalent among HIV-infected adults in Eswatini. Lower CD4+ counts are associated with greater stroke severity and increased risk of cerebrovascular events. Brain CT findings, though limited, provide valuable diagnostic insights in this population. These findings highlight the need for early ART initiation and careful neurological monitoring in immunocompromised HIV patients.