Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis

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dc.contributor.authorLoan, James J M
dc.contributor.authorPoon, Michael T C
dc.contributor.authorTominey, Steven
dc.contributor.authorMankahla, Ncedile
dc.contributor.authorMeintjes, Graeme
dc.contributor.authorFieggen, A. G
dc.date.accessioned2020-05-06T17:24:00Z
dc.date.available2020-05-06T17:24:00Z
dc.date.issued2020-04-17
dc.date.updated2020-04-20T09:07:20Z
dc.description.abstractAbstract Background 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). 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. Methods The 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. Results Seven 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). Conclusions The 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.
dc.identifier.apacitationLoan, J. J. M., Poon, M. T. C., Tominey, S., Mankahla, N., Meintjes, G., & Fieggen, A. G. (2020). Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis. <i>BMC Neurology</i>, 20(1), en_ZA
dc.identifier.chicagocitationLoan, James J M, Michael T C Poon, Steven Tominey, Ncedile Mankahla, Graeme Meintjes, and A. G Fieggen "Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis." <i>BMC Neurology</i> 20, 1. (2020) en_ZA
dc.identifier.citationLoan, J.J.M., Poon, M.T.C., Tominey, S., Mankahla, N., Meintjes, G. & Fieggen, A. G. 2020. Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis. <i>BMC Neurology.</i> 20(1) en_ZA
dc.identifier.risTY - Journal Article AU - Loan, James J M AU - Poon, Michael T C AU - Tominey, Steven AU - Mankahla, Ncedile AU - Meintjes, Graeme AU - Fieggen, A. G AB - Abstract Background 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). 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. Methods The 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. Results Seven 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). Conclusions The 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. DA - 2020-04-17 DB - OpenUCT DP - University of Cape Town KW - Systematic review KW - Meta-analysis KW - Ventriculoperitoneal shunt KW - Cerebrospinal fluid KW - Hydrocephalus KW - Human immunodeficiency virus KW - Acquired immunodeficiency syndrome LK - https://open.uct.ac.za PY - 2020 T1 - Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis TI - Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis UR - ER -en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12883-020-01713-4
dc.identifier.urihttps://hdl.handle.net/11427/31829
dc.identifier.vancouvercitationLoan JJM, Poon MTC, Tominey S, Mankahla N, Meintjes G, Fieggen A G. Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis. BMC Neurology. 2020;20(1) .en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s)
dc.sourceBMC Neurology
dc.source.journalissue1
dc.source.journalvolume20
dc.source.journalvolume141
dc.source.urihttps://bmcneurol.biomedcentral.com/
dc.subjectSystematic review
dc.subjectMeta-analysis
dc.subjectVentriculoperitoneal shunt
dc.subjectCerebrospinal fluid
dc.subjectHydrocephalus
dc.subjectHuman immunodeficiency virus
dc.subjectAcquired immunodeficiency syndrome
dc.titleVentriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis
dc.typeJournal Article
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