STEREOTAXIC BRAIN BIOPSY IN AIDS PATIENTS - DOES IT CONTRIBUTE TO PATIENT-MANAGEMENT

The authors analysed all cases of brain biopsy done in AIDS or HIV + p atients at the Department of Clinical Neurosciences, Western General H ospital, Edinburgh, during the period 1989-92 to determine the clinica l utility of the procedure. Thirteen lesions were biopsied revealing t oxoplasmosis in five, lymphoma in four, progressive multifocal leucoen cephalopathy in three, HIV encephalitis in two and encephalitis of unk nown aetiology in one. One biopsy specimen contained abnormal tissue b ut was non-diagnostic. The median survival after biopsy was only 7 wee ks, but preoperative immunological (median CD4 count 45) and clinical status of the patients were poor. Although the impact of tissue diagno sis on patient survival was minimal it did enable modification of drug therapy. The authors preliminary experience with biopsy in AIDS patie nts suggests that the diagnostic information obtained is of limited va lue in prolonging the lives of patients in poor immunological status, but may be useful in refining medical therapies for toxoplasmosis and progressive multifocal leucoencephalopathy. Whether biopsy should be p erformed earlier in the course of cerebral disease in an effort to pro long survival time remains unclear.