Original Research Redefining HIV-associated large-vessel vasculopathy in the antiretroviral therapy era: Multi-detector CT imaging findings and their correlation with intervention and patient outcomes

S'yamthanda Zondi, Ntombizakhona Madlala, Balasoobramanien Pillay

South African Journal of Radiology | Vol 30, No 1 | a3388 | DOI: https://doi.org/10.4102/sajr.v30i1.3388 | © 2026 S’yamthanda Zondi, Ntombizakhona Madlala, Balasoobramanien Pillay | This work is licensed under CC Attribution 4.0
Submitted: 16 December 2025 | Published: 15 May 2026

About the author(s) S'yamthanda Zondi, Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Ntombizakhona Madlala, Department of Radiology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Department of Radiology, Harry Gwala Regional Hospital, Pietermaritzburg, South Africa
Balasoobramanien Pillay, Department of Vascular and Endovascular Surgery, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Department of Vascular Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa

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 (χ2) and logistic regression to identify predictors of adverse outcomes.
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.

Keywords

HIV-associated large-vessel vasculopathy; multi-detector computed tomography; CT angiography; aneurysm; occlusive

Sustainable Development Goal

Goal 3: Good health and well-being

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