A COMPARISION OF BRAIN BIOPSY AND CSF-PCR IN THE DIAGNOSIS OF CNS LESIONS IN AIDS PATIENTS

Twenty patients with AIDS who had intracranial lesions underwent both brain biopsy and cerebrospinal fluid (CSF) examination to compare hist ological diagnosis with the polymerase chain reaction (CSF-PCR) for th e identification of infectious agents. CSF-PCR was per formed for herp es simplex vir-us, varicella tester virus, cytomegalovirus (CMV), JC v irus (JCV), Epstein-Barr virus (EBV), Toxoplasma gondii and Mycobacter ium tuberculosis. A definitive diagnosis was obtained by brain biopsy in 14 patients (2 with astrocytoma, 12 with brain infection). CSF-PCR was positive for EBV DNA in 3 of 3 cases of primary cerebral lymphoma, positive for JCV DNA in 6 of 7 biopsy-proven (and one autopsy-proven) cases of progressive multifocal leukoencephalopathy (PML). CSF-PCR wa s positive fur CMV DNA in one biopsy-proven and one autopsy-proven cas e of CMV encephalitis (the former also had PML) and positive for M. tu berculosis DNA in one case of tuberculous encephalitis. None of the fi ve toxoplasmic encephalitis cases (one definite, four presumptive) wer e T. gondii DNA positive. There was close correlation between histolog y and CSF-PCR for CMV encephalitis, PML and PCL. Antitoxoplasma therap y affected the sensitivity of both histological and CSF-PCR methods.