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Cranial computed tomography (CT) remains valuable for the identification of opportunistic pathologies in AIDS patients in low-income countries. Delayed iodinated contrast medium CT images have the potential to better demonstrate inflammatory-infectious or neoplastic opportunistic pathologies. The main objective of this study was to optimize the protocol for cranial CT in patients with AIDS and clinical signs of opportunistic pathologies at the authors' institution. It was hypothesized that 20-min delayed contrast-enhanced CT images would be sufficient to optimize the detection of brain pathologies and that no additional delayed images would be necessary. Twenty-six adult patients with AIDS and brain pathologies were enrolled and had their cranial CT images analyzed by three evaluators. The numbers of lesions identified at two predetermined delayed time-points were compared. There was no variation in the number of lesions depicted by each evaluator, between the 20-min delayed contrast-enhanced CT image and the image obtained at the other predetermined delayed time-point.