Management of HIV-associated focal brain lesions in developing countries.
BACKGROUND
HIV-associated focal brain lesions (HFBL) are caused by opportunistic infections, neoplasms, or cerebrovascular diseases. In developed countries, toxoplasma encephalitis (TE) is the most frequent cause, followed by primary CNS lymphoma (PCNSL). Guidelines based on these causes however are poorly suited to developing countries, where treatable infections predominate as causes of HFBL.


OBJECTIVE
To determine a practical approach to the management of HFBL in developing countries.


METHODS
Case series.


METHODS
Patients (n = 32) were managed based on presumed aetiologies of the focal brain lesions, determined by collating information from CT scans, CSF and blood studies, concurrent non-neurological illness and response to treatment.


RESULTS
The principal presumed cause of HFBL was tuberculosis (69%). The therapeutic response was good in 69% of patients.


CONCLUSIONS
In developing countries, infections are the predominant cause of HFBL, the principal causes being infections that are endemic to the populations being studied. Empiric treatment based on limited investigations should be directed according to the nature of such infections. A modified algorithm is proposed.
Modi
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Division of Radiology, Department of Radiation Sciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. gmodicns@mweb.co.za
Mochan
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Modi
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D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000995:Antitubercular Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications* / Q000276:immunology / Q000821:virology; D018791:CD4 Lymphocyte Count; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013019:South Africa; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020306:Tuberculosis, Central Nervous System / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D019562:Viral Load
D000995:Antitubercular Agents