Management of HIV-associated focal brain lesions in developing countries - experience at Chris Hani Baragwanath Hospital
Background. HIV-associated focal brain lesions (FBLs) are caused by opportunistic infections, neoplasms, or cerebrovascular diseases. In developed countries toxoplasma encephalitis (TE) is the most frequent cause followed by primary CNS lymphoma (PCNSL). Guidelines based on these causes have been proposed and successfully implemented. These guidelines do not consider the causes of HIV-associated FBL in developing
countries where treatable infections predominate. The guidelines as proposed would adversely influence outcome if applied to patients in developing countries. Objective. To determine a practical approach to the management of HIVassociated FBLs in developing countries. Design. Prospective case series. Methods.Management based on presumed
aetiologies of the FBLs determined by collating information obtained from computed tomography (CT) scans, cerebrospinal fluid and blood studies, concurrent nonneurological
illness and response to treatment. Results. The principal presumed cause of FBL was tuberculosis (TB) (69%), and the therapeutic response was good in 69% of patients.
Conclusions. In developing countries infections are the predominant cause of HIV-associated FBL. The principal cause is determined by the infection that is endemic to the population being studied. Empiric treatment based on limited investigations should
be directed according to the nature of this infection.A modified algorithm is proposed
South African Journal of Radiology Vol. 9 (2) 2005: pp. 5-13