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Open Access Short report

Brain biopsy in AIDS patients: diagnostic yield and treatment applications

Zion Zibly7, Itzchak Levy3, Vlady Litchevski3, Dvora Nass2, Chen Hofmann4, Jacob Barham5, Christian A Graves6, Roberto Spiegelmann1, Moshe Hadani1 and Zvi R Cohen1*

Author Affiliations

1 Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel

2 Institute of Pathology, Sheba Medical Center, Ramat Gan, Israel

3 AIDS Center, Sheba Medical Center, Ramat Gan, Israel

4 Institute of Radiology, Sheba Medical Center, Ramat Gan, Israel

5 The Oncology Center, Sheba Medical Center, Israel, Ramat Gan, Israel

6 Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Carolina, SC, Columbia

7 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

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AIDS Research and Therapy 2014, 11:4  doi:10.1186/1742-6405-11-4

Published: 21 January 2014

Abstract

Objective

Central nervous system involvement in AIDS patients can present at any stage of the disease. Brain lesions detected in imaging studies are usually treated empirically. A brain biopsy is indicated in the absence of clinical and radiologic improvement. In the present study, 16 AIDS patients underwent brain biopsy. We evaluated the diagnostic yield of the brain biopsy and the changes in the disease course.

Materials and methods

Sixteen consecutive AIDS patients (12 men, 4 women; mean age 40.8 years) underwent a brain biopsy at Sheba Medical Center between 1997 and 2009. A retrospective analysis was performed and the clinical outcome was recorded.

Results

Median CD4 count before biopsy was 62.6. Magnetic resonance images revealed multiple lesions in 12 patients and enhancing lesions in 12 patients. A total of 19 biopsies were performed in 16 patients. In the present series, the initial procedures provided a diagnostic yield of 81.25% (13 diagnostic cases from 16 procedures in 16 patients). Two of these patients underwent repeated biopsies that were eventually diagnostic . If repeated biopsies were taken into consideration, the diagnostic yield was 93.75% (15 diagnostic cases in 16 patients). The rate of hemorrhagic complications was 10.5% (2 hemorrhages in 19 procedures).

Pathologic examination revealed parasitic and fungal infections in 6 patients (6/16; 38%), progressive multifocal leukoencephalopathy in 4 patients (4/16; 25%), AIDS encephalopathy in 4 patients (4/16; 25%), and lymphoma in 1 patient (1/16; 6%). One patient had a nonspecific inflammatory process (6%). The treatment modality was modified in 12 patients and led to clinical and radiologic improvement in 8 patients.

Conclusions

Brain biopsy should be considered when empiric treatment of central nervous system lesions in AIDS patients fails. Biopsy is diagnostic in the majority of patients. The diagnosis allows for treatment modifications, which lead to clinical and radiologic improvement in some patients.

Keywords:
HIV; Brain biopsy; CNS AIDS; Neuroimmunology