gms | German Medical Science

Objective: At some point during their disease a significant number of HIV infected patients develop neurologic symptoms due to intracerebral pathologies. Entities commonly found in HIV patients are toxoplasmosis, lymphomas, or progressive multifocal leukencephalopathy (PML). Most often these can be diagnosed reliably. However, in a considerable number of patients correct diagnosis determining adequate therapy is not feasible with imaging alone. In this situation biopsy is required. The objective of this study is to evaluate the impact of stereotactic biopsy in HIV patients on change and adjustment of given therapy.

Method: Between 2004 and December 2013, 22 HIV infected patients harboring symptomatic intracerebral findings of unknown etiology underwent stereotactic biopsy in our Clinic. In all patients thin layer MRI images were obtained and fused with CT scans that were taken immediately preoperatively with the stereotactic frame (Leksell) mounted. Using the Elekta^® stereotactic brain system and Brainlab^® navigation, entry and target points were meticulously planned resulting in the most appropriate trajectory. Biopsy material was both evaluated pathologically as microbiologically.

Results: Histological analysis revealed B-cell Lymphoma in 27.3% (n=6) of the patients, PML in 9.1% (n=2), and toxoplasmosis in 4.5% (n=1). An abscess was found in three patients (13.6%) and necrotic encephalitis in two (9.1%). HIV associated vasculitis was diagnosed in two patients (9.1%) and further findings comprised Non-Hodgkin-Lymphoma, Burkitt Lymphoma, carcinoma metastasis, and glioblastoma in one patient each. Toxoplasmosis was the underlying cause in one patient with an abscess as well as in another patient with necrotic encephalitis. In two patients (9.1%) no diagnosis could be established.

After biopsy medical treatment was significantly changed in 63.6% (n=14) of the patients. Among these antibiotic therapy was adjusted in four patients (28.6%) and chemotherapy was in three (21.4%). Other changes included antibiotic therapy to chemotherapy in three patients (21.4%) and chemotherapy to radiation, cortisone to chemotherapy, and aciclovir to cortisone in one patient each. In one patient (7.1%) therapy was changed to palliative care.

Conclusions: In the event of intracerebral findings of unknown etiology stereotactic biopsy in HIV infected patients has an enormous impact on further treatment strategy resulting in significant changes of therapy in about two-thirds of the patients.