Intracranial mass lesions in HIV-positive patients - The Kwazulu/Natal experience

Background. Neurological disease heralds the development of AIDS in 10 - 20 % of HIV-seropositive individuals. In over half of these cases the presenta tion will be that of an intracranial mass lesion (IML). In developed countr ies toxoplasmosis is the most frequent cause of: IML in a positive patient, followed by primary central nervous system lymphoma. Less common causes in clude tuberculomas, cryptococcomas, abscesses and gummas. As a result of th ese observations, the algorithm adopted in developed countries calls for in itial empirical treatment for toxoplasmosis. Biopsy of the IML is only cons idered if there is no response to treatment after 10 - 14 days. Whether suc h an algorithm would be applicable to the local population is unknown. Objective. We undertook a prospective study to determine the type and frequ ency of IML in local HIV-seropositive patients. A secondary objective, base d on the findings, was to develop a local algorithm of management. Patients and Methods. Over a 17-month period HIV-seropositive individuals w ith an IML were entered into the study. Biopsy or aspiration of the lesion was performed either stereotactically or free-hand. Tissue obtained was pro cessed for routine and special histological studies. Results. In the 38 cases where tissue was obtained, the most frequent cause of the IML was toxoplasmosis followed by 'encephalitis of obscure origin', brain abscess and tuberculoma/mycobacterial infection. Conclusion. This study demonstrated that the spectrum of IML seen locally w as similar to that in developed countries, The management protocol used els ewhere was therefore adopted for local patients.