Utility of brain biopsy in patients with acquired immunodeficiency syndrome before and after introduction of highly active antiretroviral therapy.
OBJECTIVE
This study investigates the changing indications, results, and practice patterns of brain biopsy in patients with acquired immunodeficiency syndrome (AIDS) as treatment evolved with the development of highly active antiretroviral therapy (HAART).


METHODS
We collected data on 246 patients with AIDS who were undergoing brain biopsy of intracranial lesions. Patients were managed in accordance with a uniform protocol. Patients were divided into two groups of those biopsied in the era before (1992-1996) or after (1997-2001) the use of HAART.


RESULTS
The introduction of HAART led to a steep decrease in the number of biopsies performed annually. The protocol functioned well. Diagnoses were obtained for 92.3% of patients. Lymphoma was the most frequent diagnosis (52.9% of patients), followed by progressive multifocal leukoencephalopathy (18.9% of patients) and toxoplasmosis (8.1% of patients). No patient who underwent lesion biopsy for reasons of negative toxoplasmosis titers or atypical radiology evaluation was diagnosed with toxoplasmosis. Nineteen patients who experienced failed toxoplasmosis treatment were diagnosed with toxoplasmosis. Toxoplasmosis titers had a high specificity and a negative predictive value. Patients with progressive multifocal leukoencephalopathy or nondiagnostic biopsies were more likely to have solitary lesions. The average Karnofsky performance score at the time of biopsy was 72.4, which is still within the range of independent functioning. Significant intracerebral hemorrhages were only observed in patients with lymphoma who also had low platelet counts.


CONCLUSIONS
Although the number of patients with AIDS who require brain biopsy has decreased, the procedure still has merits. The paradigm we developed was useful for selecting patients for early biopsy. Patients with AIDS who also have intracerebral lesions should have toxoplasmosis titers performed, and those whose titers are negative for toxoplasmosis should undergo early brain biopsy.
Rosenow
Joshua M
JM
Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. jrosenow@nmff.org
Hirschfeld
Alan
A
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome