Intracranial mass lesions in HIV-positive patients--the KwaZulu/Natal experience. Neuroscience AIDS Research Group

Abstract

Background: Neurological disease heralds the development of AIDS in 10-20% of HIV-seropositive individuals. In over half of these cases the presentation will be that of an intracranial mass lesion (IML). In developed countries toxoplasmosis is the most frequent cause of IML in a positive patient, followed by primary central nervous system lymphoma. Less common causes include tuberculomas, cryptococcomas, abscesses and gummas. As a result of these observations, the algorithm adopted in developed countries calls for initial empirical treatment for toxoplasmosis. Biopsy of the IML is only considered if there is no response to treatment after 10-14 days. Whether such an algorithm would be applicable to the local population is unknown.

Objective: We undertook a prospective study to determine the type and frequency of IML in local HIV-seropositive patients. A secondary objective, based on the findings, was to develop a local algorithm of management.

Patients and methods: Over a 17-month period HIV-seropositive individuals with an IML were entered into the study. Biopsy or aspiration of the lesion was performed either stereotactically or free-hand. Tissue obtained was processed for routine and special histological studies.

Results: In the 38 cases where tissue was obtained, the most frequent cause of the IML was toxoplasmosis followed by encephalitis of obscure origin', brain abscess and tuberculoma/mycobacterial infection.

Conclusion: This study demonstrated that the spectrum of IML seen locally was similar to that in developed countries. The management protocol used elsewhere was therefore adopted for local patients.