Related Experiment Videos
Changing disease patterns in focal brain lesion-causing disorders in AIDS
A Ammassari1, G Scoppettuolo, R Murri
1Department of Infectious Diseases, Catholic University, Rome, Italy. iclmi@romamilano.unicatt.it
Summary
Toxoplasmic encephalitis (TE) risk declined significantly in HIV patients from 1991-1996, while other focal brain lesions (FBL) like PCNSL increased. CDC criteria for TE became less reliable, necessitating new diagnostic approaches.
Area of Science:
- Neurology
- Infectious Diseases
- Medical Imaging
Background:
- HIV-infected patients are susceptible to various focal brain lesions (FBL).
- Toxoplasmic encephalitis (TE) was a common FBL, diagnosed using U.S. Centers for Disease Control and Prevention (CDC) criteria.
- The reliability of CDC criteria for TE diagnosis over time needed evaluation.
Purpose of the Study:
- To analyze temporal trends of FBL in HIV patients (1991-1996).
- To assess the accuracy of CDC criteria for presumptive TE diagnosis during this period.
Main Methods:
- Prospective, monocenter study analyzing FBL occurrence percentages annually.
- Statistical analysis of temporal trends using chi-squared and logistic regression.
- Calculation of the positive predictive value (PPV) of CDC criteria for TE diagnosis each year.
Main Results:
- A significant decrease in TE risk was observed, correlating with increased anti-Toxoplasma prophylaxis.
- Diagnoses of primary central nervous system lymphoma (PCNSL) and progressive multifocal leukoencephalopathy (PML) increased.
- The PPV of CDC criteria for TE dropped from 100% in 1991 to 39% in 1996.
Conclusions:
- Empiric anti-Toxoplasma therapy is no longer suitable as a first-line approach for all HIV-positive patients with FBL.
- Increased incidence of PCNSL and other FBL necessitates new diagnostic strategies, especially for contrast-enhancing lesions.
- Accurate and rapid identification of underlying FBL disorders is crucial for effective patient management.