ArticleSA journal of radiology2026
Redefining HIV-associated large-vessel vasculopathy in the antiretroviral therapy era: Multi-detector CT imaging findings and their correlation with intervention and patient outcomes.
Article in SA journal of radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: HIV-associated large-vessel vasculopathy (HALVV), previously described as a distinct entity characterised by young patients with atypical aneurysmal sites and few traditional risk factors, is now recognised across a wider age range in the antiretroviral therapy (ART) era. It continues to demonstrate aneurysmal and occlusive patterns distinct from conventional atherosclerotic disease. Despite its clinical importance, systematic correlations between imaging findings, management strategies and outcomes remain limited, particularly in sub-Saharan Africa. Objectives: This study aimed to characterise the multi-detector computed tomography (MDCT) angiographic features of HALVV and assess their association with intervention and clinical outcomes. Method: A retrospective observational study was conducted at Inkosi Albert Luthuli Central Hospital (IALCH) between 2018 and 2023. HIV-positive adults with extracranial large-vessel vasculopathy undergoing MDCT angiography were included. Associations between imaging findings, intervention and outcomes were assessed using the Pearson's chi-squared test (χ Results: A total of 210 patients were included; 90 had aneurysmal disease, and 120 had occlusive disease. Fusiform aneurysms predominated (55.6%), and endovascular intervention was performed in 51.1% of cases. Device-related complications included type I and II endoleaks (13.3%) and stent failure (4.4%). Common iliac artery aneurysm independently predicted adverse device-related outcomes. Occlusive disease was predominantly long segment (85.8%), frequently multivessel (≥ 3 vessels in 70.8%) and associated with a high amputation rate (53.4%). Conclusion: Multi-detector CT angiography demonstrates distinct HALVV phenotypes with direct management implications. Endovascular treatment of aneurysmal HALVV shows favourable short-term outcomes but requires vigilant surveillance, particularly with iliac involvement. Occlusive HALVV is characterised by diffuse disease and poor limb salvage outcomes. Contribution: This study provides ART-era MDCT imaging-outcome correlations for HALVV in a South African tertiary setting.
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