title: Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients.
abstract: Early brain biopsy may be indicated in HIV patients with focal brain lesion. This study aimed to evaluate and compare the safety and diagnostic value of brain biopsy in HIV patients in the pre-highly active antiretroviral therapy (HAART) versus post-HAART era via meta-analysis. Appropriate studies were identified per search criteria. The local database was retrospectively reviewed to select a similar patient cohort. Patient demographics, brain biopsy technique, histopathology and patient outcomes were extracted from each study. Study-specific outcomes were combined per random-effects model. Outcomes were compared between the pre-HAART and post-HAART era. Correlations between outcomes and baseline characteristics were assessed via meta-regression analysis. The proportions of histopathological diagnosis were tabulated and compared between the pre- and post-HAART era. Survival analysis was performed for patients in the post-HAART era. A total of 26 studies (including the local database) with 1209 patients were included in this meta-analysis. The most common indications for brain biopsy were diagnosis unlikely to be toxoplasmosis (n=8, 42.1%), focal brain lesion (n=5, 26.3%) or both (n=3, 15.8%). The weighted proportions for diagnostic success were 92% (95% CI 90.0% to 93.8%), change in management 57.7% (45.9% to 69.1%) and clinical improvement 36.6% (26.3% to 47.5%). Morbidity and mortality were 5.7% (3.6% to 8.3%) and 0.9% (0.3% to 1.9%), respectively. Diagnostic success rate was significantly higher in the post-HAART than the pre-HAART era (97.5% vs 91.9%, p=0.047). The odds ratio (OR) for diagnostic success in patients with contrast-enhanced lesions was 2.54 ((1.25 to 5.15), p<0.01). The median survival for HIV patients who underwent biopsy in the post-HAART era was 225 days (90-2446). Brain biopsy in HIV patients is safe with high diagnostic yield. Early brain biopsy should be considered in patients without classic presentation of toxoplasmosis encephalitis.
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Lee
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Harrison X
authors.initials: HX
authors.lastname: Bai
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Zou
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Dongxu
authors.initials: D
authors.lastname: Qiu
authors.affiliation: Department of Pathology, The First Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Martinez-Lage Alvarez
authors.affiliation: Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Cancer Research Institute of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Yongguang
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Xiangqi
authors.initials: X
authors.lastname: Tang
authors.affiliation: Department of Neurology, The First Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xiao
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D019983:Guideline Adherence; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013223:Statistics as Topic; D016019:Survival Analysis; D016781:Toxoplasmosis, Cerebral / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D016896:Treatment Outcome
keywords: AIDS; INFECTIOUS DISEASES; PATHOLOGY