Trauma SAJS

Since the first descriptions of acquired immune deficiency syndrome (AIDS) in homosexual men in San Francisco in 1981, HIV has commonly been associated with and implicat-ed in the pathogenesis of vascular disease. The South African experience of HIV-related aneurysms occurring in young HIV-infected individuals suggested a distinct clinicopatho-logical entity, based on distribution, morphological descrip-tion and histopathological findings.1,2 Less convincing, but occurring more frequently in younger HIV-infected South Africans, has been an apparently unique type of vascular occlusive disease.3 This has generally been encountered in those individuals with advanced disease and significant immunocompromise. These manifestations are not unique to South Africa, and have also been described elsewhere.4 Although many reports preceded the highly active anti-retroviral treatment (HAART) era, they still occur in areas where HAART is not available. Very few descriptions of HIV-associated vasculopathy in other sites, such as the cerebral, coronary, renal or mesenteric territories, have been reported in the surgical literature. This is understandable, considering that much of the pathology manifests as systemic vasculitides, with very limited surgical treatment options. Systemic vascu-litides, however, have been reported in less than 1 % of HIV patients, predominantly affecting skin, muscle and nerves and very rarely other organ systems. The advent of HAART has dramatically modified out-comes in HIV/AIDS, with concerns now being expressed about the older HIV population group exposed to long-term HAART now being more susceptible to precocious and/or accelerated atherosclerotic vascular disease. The aetiology of vasculopathy in HIV-infected individuals has been widely debated, and is probably multifactorial. For practical purposes HIV vasculopathy may be classified as: • HIV-related vasculitis • HIV/HAART-related atherosclerotic vascular disease • mixed (both pathologies occurring in the same patient). HIV-related vasculitis can further be subclassified into four types:5 Type I: Vasculitides that are well described in the non-HIV population group but occur coincidentally in HIV-infected individuals (Takayasu’s disease, Behçet’s disease, giant cell arteritis, polyarteritis nodosa, etc.)