Primary intracranial neoplasms in patients with HIV

Objective: To report a series of HIV-infected patients with intracranial tu mors not known to be associated with immunodeficiency. Background: The spec trum of HIV-associated diseases is changing with improved treatments and pr olonged patient survival. Although primary central nervous system lymphoma (PCNSL) and toxoplasmosis continue to be the most common intracranial lesio ns in HIV-infected patients, the recognition of other pathologic entities i s increasingly important. Methods: The clinical characteristics and outcome of eight HIV-infected patients with nine intracranial neoplasms other than PCNSL are reported. In addition, all available pathologic specimens were t ested for evidence of either HIV or Epstein-Barr virus (EBV) infection. An additional 28 patients reported in the literature are summarized. Results: Five of eight patients had a glioblastoma multiforme; other tumors included an anaplastic ependymoma, a low-grade glioma, a subependymoma, and a leiom yosarcoma. More than half of the patients developed their tumor greater tha n or equal to 6 years after the diagnosis of HIV infection. Patient prognos is and survival was best predicted by tumor histology. Treatment response a nd outcome did not appear to be influenced by HIV infection. Only the leiom yosarcoma demonstrated evidence of latent EBV infection. Conclusions: HIV-i nfected patients are at risk for intracranial neoplasms other than PCNSL, a nd benefit from aggressive tumor-specific therapy. It is possible that glio mas are occurring at a higher rate than in the general population. There wa s no evidence of HIV or EBV infection in any glial tumor.