Brain biopsy in patients with acquired immunodeficiency syndrome - Diagnostic value, clinical performance, and survival time

Background: Despite extensive discussion in recent years, brain biopsy in p atients positive for human immunodeficiency virus who manifest cerebral mas s lesions remains an ill-defined step in management. Methods: Prebiopsy data of 26 human immunodeficiency virus-positive patient s with cerebral mass lesions who underwent computed tomography-guided stere otactic brain biopsy (SBB) were reviewed by a specialist in infectious dise ases and by a neuroradiologist to establish a clinical diagnosis and a trea tment plan for each patient. The postbiopsy diagnosis was compared with the prebiopsy diagnosis. Long-term patient outcome after SBB was recorded by m eans of a clinical performance scale to estimate its impact on life expecta ncy and clinical performance. Results: The SBB was diagnostic in 25 patients (96%). Potentially treatable disease was diagnosed in 21 patients (81%), and specific therapy was initi ated in 17 patients (65%), 10 patients (39%) were able to complete therapy. The SBB corroborated the clinical diagnosis in 13 (52%) of 25 patients. Th e group with identical clinical and biopsy-proved diagnoses showed signific antly better response to therapy (P =.02), clinical performance (P =.04), a nd survival after biopsy (P =.01), as compared with the group with differen t clinical and biopsy-proved diagnosis, although no significant difference was found for the degree of immunosuppression. Only completion of the treat ment plan increased life expectancy significantly (P =.008). Conclusions: These data show that in human immunodeficiency virus-positive patients with brain mass lesions, SBB has a high diagnostic yield. A subgro up of patients will benefit from specific therapy guided by the SBB result. The procedure should, however, be strictly limited to patients able to tol erate specific therapy.