title: Impact of Stereotactic Biopsy in HIV Patients.
abstract: OBJECTIVE
  During their disease a significant number of human immunodeficiency virus (HIV)-infected patients develop neurologic symptoms due to intracerebral pathologies. Entities commonly found are toxoplasmosis, lymphomas, or progressive multifocal leukoencephalopathy. In some patients, diagnosis is not feasible with imaging alone, requiring biopsy. The objective of this study was to evaluate the impact of stereotactic biopsy in HIV patients on adjustment of therapy.
  
  
  METHODS
  Between January 2004 and May 2015 at our clinic, 26 HIV-infected patients underwent stereotactic biopsy. Thin-layer magnetic resonance images were obtained and fused with computed tomography scans, taken with the stereotactic frame (Leksell) mounted. Biopsy material was evaluated pathologically and microbiologically.
  
  
  RESULTS
  Histologic analysis revealed B-cell lymphoma in 6 patients (23.1%) and progressive multifocal leukoencephalopathy in 2 patients (7.7%). Abscess and toxoplasmosis were found in 3 patients each (11.5% and 11.5%), and encephalitis occurred in 4 patients (15.4%). In 2 patients each (7.7%), vasculitis, metastasis, and glioblastoma were diagnosed. Further findings comprised non-Hodgkin lymphoma and Burkitt lymphoma in 1 patient each. After biopsy, treatment was significantly changed in 18 (69.2%) patients (P < 0.01). Antibiotic therapy was adjusted in 6 patients (23.1%), and chemotherapy in 3 patients (16.7%). Other changes included antibiotic/antiviral therapy to chemotherapy in 3 patients (16.7%), chemotherapy to radiation, cortisone to chemotherapy, and aciclovir to cortisone in 1 patient each. One patient with glioblastoma underwent resection, and another patient received radiation. One patient underwent palliative care.
  
  
  CONCLUSIONS
  Stereotactic biopsy in HIV-infected patients results in significant changes of therapy in more than two thirds of the patients.
authors.affiliation: Neurosurgical Clinic, Goethe-University Frankfurt, Germany. Electronic address: johanna.quick@gmx.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Quick-Weller
authors.affiliation: Medical Clinic II, Goethe-University Frankfurt, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Kann
authors.affiliation: Institute for Neuroradiology, Goethe-University Frankfurt, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lescher
authors.affiliation: Neurosurgical Clinic, Goethe-University Frankfurt, Germany.
authors.forename: Lioba
authors.initials: L
authors.lastname: Imöhl
authors.affiliation: Neurosurgical Clinic, Goethe-University Frankfurt, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.affiliation: Neurosurgical Clinic, Goethe-University Frankfurt, Germany.
authors.forename: Lutz Martin
authors.initials: LM
authors.lastname: Weise
authors.affiliation: Medical Clinic II, Goethe-University Frankfurt, Germany.
authors.forename: Hans-Reinhard
authors.initials: HR
authors.lastname: Brodt
authors.affiliation: Neurosurgical Clinic, Goethe-University Frankfurt, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Marquardt
mesh_terms: D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007013:Hypopharynx / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed
keywords: AIDS; HIV; Stereotactic biopsy