STEREOTACTIC BRAIN BIOPSY IN AIDS-PATIENTS - AN IMPORTANT, PATIENT-CENTERED AND COST-EFFECTIVE DIAGNOSTIC PROCEDURE

Neurological complications occur in 40% of ''human immunodeficiency vi rus type 1'' (HIV-1) -infected patients. Aim of the study was to evalu ate the diagnostic yield of stereotactic brain biopsy and non invasive diagnostic procedures (CT, antitoxoplasma antibodies) and to calculat e the benefit of the brain biopsy for the patient and the costs of bot h methods. From October 1989 through September 1995 we biopsed 44 of 2 749 (2%) HIV-1-infected patients after non invasive diagnostic procedu res had been performed. In 93% of the patients an unambigous diagnosis was possible based on the biopsy and lead in 73% of the patients to a change of therapy. No complications occurred after biopsy. 40 CTs and 15 MRIs were done. The radiological appearance of toxoplasmosis and n on Hodgkin lymphoma (NHL) differed from that of progressive multifocal leucencephalopathy (PML) in respect to enhancement (PML). CT showed a sensitivity of 55% (toxoplasmosis, NHL) and 78% (PML) and a specifici ty of 83% (PML), 84% (NHL) and 96% (toxoplasmosis), respectively. Anti toxoplasma antibodies showed a sensitivity of 45%, only. The stereotac tic brain biopsy was mon expensive (20.166,ATS) than CT, MRI and antit oxoplasma antibodies (4109, ATS up to 6959,- ATS). We conclude that st ereotactic brain biopsy is an efficient and safe and for the patients important diagnostic procedure. In selected patients even expensive in vestigations should be undertaken considering specific therapy and cos t effective homecare.