Computer tomographic findings of the brain in HIV-patients at Ramathibodi Hospital

To determine the underlying cause of the brain lesions in adult HIV patients referred for CT scan at Ramathibodi Hospital and to evaluate accuracy of CT for the diagnosis of the brain lesion.

Data from first CT scan of the brain of 195 adult HIV patients at Ramathibodi Hospital were reviewed The final diagnoses from medical records were assessed followed by CSF analysis, pathological report, and therapeutic treatment. The accuracy of the CT brain was evaluated using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

One hundred ninety five adult seropositive patients for HIV underwent CT scan of the brain, 59% were HIV encephalopathy (HIVE), 22% toxoplasmosis, 9% cryptococcoma, 5% tuberculous meningitis, 4% tuberculoma, 3% progressive multifocal leukoencephalopathy (PML), 2% lymphoma, and 1% normal. In non-specified causes (from CT scan), 33% were meningitis, 4% cerebritis, and 5% infarction. CT was found to have high sensitivity, specificity, PPV, and NPV for toxoplasmosis (92%, 96%, 86%, and 98%, respectively).

HIV encephalopathy was the most common finding of adult HIV brains. Toxoplasmosis was the most common opportunistic parenchymal brain lesion in adult HIV brains. CT was the modality of choice for diagnosis and exclusion of toxoplasmosis, but it cannot determine the cause of disease showing meningitis pattern.