Brain biopsy in AIDS patients: diagnostic yield and treatment applications

Zibly, Zion; Levy, Itzchak; Litchevski, Vlady; Nass, Dvora; Hofmann, C.; Barham, J. R.; Graves, Christian; Spiegelmann, Roberto; Hadani, Moshe

doi:10.1186/1742-6405-11-4

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…Studies would be more likely to report separate data for patients with contrast-enhanced lesions versus those with unenhanced lesions when there was a difference in diagnostic success rate. However, two studies (of eight) actually had ORs close to 1,20 31 thereby rebutting our original hypothesis. Enhancement signifies the presence of inflammation.…”

Section: Discussionmentioning

confidence: 64%

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Lee

Bai

Zou

et al. 2016

J Neurol Neurosurg Psychiatry

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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.

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Section: Discussionmentioning

confidence: 64%

Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients

Lee

Bai

Zou

et al. 2016

J Neurol Neurosurg Psychiatry

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“…Studies were excluded if they met any of the following criteria: a patient population <10; a study population already included in another study; a patient cohort retrospectively selected based on a certain diagnosis, such as PML; the samples were collected by another form of biopsy, such as craniotomy; incomplete data; and the manuscript was a commentary, technical note or review. A total of 19 studies were included for review [3,5,10,12–27] (Table 4). The average positive biopsy rate, complication rate, and hemorrhage morbidity and mortality were 80.00% to 100% (mean 90.98%, 746/820), 0% to 20.00% (mean 5.93%, 37/624), 0% to 18.18% (mean 3.84%, 24/624), and 0% to 9.09% (mean 2.08%, 13/624), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, we also analyzed the diagnostic results in the literature and found the following: in 17 studies [3,5,10,13–25,27] with 678 patients, there were 208 cases of lymphoma (30.68%), 171 cases of PML (25.22%), 131 cases of TE (19.32%), 48 cases of HIV encephalitis (7.08%), 5 cases of CMV (0.74%), 26 cases with multiple diagnoses (3.83%), and 48 cases with nonspecific positive results (7.08%) (Table 5). Obviously, the most common intracranial lesions included lymphoma, PML, and TE.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Many (40–60%) patients develop neurological abnormalities during the disease course. [5] Moreover, 75% to 80% of all AIDS patients show neuropathological changes in the CNS upon brain autopsy, [6] and multiple pathologies are found in 17% of cases. [7] …”

Section: Introductionmentioning

confidence: 99%

“…Brain biopsy is indicated in the absence of clinical and radiologic improvement after empiric therapy. [5] …”

Section: Introductionmentioning

confidence: 99%

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Application of stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS in China

Zhang

Fu²,

Gong³

et al. 2016

Medicine

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Rationale:The aim of the study was to evaluate stereotactic biopsy for diagnosing intracranial lesions in patients with AIDS.Patient concerns:Seven AIDS patients with an intracranial lesion who underwent stereotactic biopsy were included in this retrospective study (4 males and 3 females, 15 to 49 years old). The patients’ disease history ranged from 1 month to 1 year. The samples were examined by hematoxylin-eosin (HE) staining and immunohistochemical examination.Diagnoses, interventions and outcomes:All patients were successfully sampled, and the histological results showed inflammation in 4 cases, toxoplasma gondii infection in 1 case, astrocytoma in 1 case, and abscess in 1 case. The clinical diagnosis included toxoplasma encephalitis (TE) in 2 cases, cryptococcus encephalitis in 2 cases, cytomegalovirus (CMV) encephalitis in 2 case, tubercular abscess in 1 case, astrocytoma in 1 case, and co-infection of TE with Cryptococcus infection in 1 patient. The clinical diagnosis was made according to the plasma and cerebrospinal fluid (CSF) laboratory testing, the imaging data and the histological findings. The diagnostic yield was 100%, and the post-operation morbidity was 14.3% (1/7) with an asymptomatic haemorrhage and seizure in 1 case. There was no operation-related mortality. Patients were followed up for 6 months to 6 years; 1 case fully recovered, 4 cases significantly improved in symptoms, and 2 died.Lessons:Stereotactic biopsy is a safe and effective way of diagnosing intracranial lesions in patient with AIDS. It is helpful for the differential diagnosis and for choosing a suitable therapy. Due to the broad spectrum of nervous system abnormalities in AIDS, histological findings are very valuable. However, histology is not a unique tool for making a definite diagnosis, whereas the combination of molecular pathology and stereotactic biopsy should play a more important role in the future.

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