South African Journal of Radiology

Background: Radiological imaging is crucial for diagnosing hepatic cystic echinococcosis (HCE) and assessing complications. Case studies suggest HCE with human immunodeficiency virus (HIV) co-infection is associated with larger, more multilocular cysts, increased extrahepatic dissemination, rupture, secondary infection and biliary invasion.
Objectives: To compare the radiological presentation of HCE in HIV-positive (HIV+) and HIV-negative (HIV-) patients and determine whether HIV co-infection influences imaging features.
Method: Pre-operative imaging (chest X-rays, ultrasound, CT and MRI of HIV+ and HIV- HCE patients at our tertiary facility between 2011 and 2023 was reviewed. Cyst characteristics and disease staging (WHO and Gharbi classifications) were independently assessed by two blinded radiology specialists.
Results: Eighty-six patients (45 HIV+, 63 females) were included. Single unilocular cysts predominated (37.8% HIV+ and 36.6% HIV-). Extrahepatic cysts occurred in 40% of HIV+ and 34.1% of HIV- patients. Right hepatic lobe involvement was more common in HIV+ patients (86% vs. 62.5%). Median cyst diameter was 14.2cm in HIV+ vs. 11.3cm in HIV- patients. Rates of biliary communication, bile duct dilatation, intraperitoneal cyst rupture and cyst infection were similar in HIV+ versus HIV- patients (11.1% vs 12.2%, 11.1% vs 17.1%, 20% vs. 26.8% and 8.9% vs. 19.5%, respectively), as was WHO and Gharbi stage distributions.
Conclusion: HIV prevalence (52.3%) exceeded the national prevalence (12.7%), supporting hypotheses that HCE may self-limit less frequently in HIV+ patients. However, co-infection was not associated with more advanced or complicated radiological disease.
Contribution: Imaging remains central to HCE diagnosis and management, particularly in HIV+ individuals, where serological testing is less reliable.