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 presentation will be that of an intracranial mass lesion (IML). In developed countries toxoplasmosis is the most frequent cause of IML in a positive patient, followed by primary central nervous system lymphoma. Less common causes include tuberculomas, cryptococcomas, abscesses and gummas. As a result of these observations, the algorithm adopted in developed countries calls for initial empirical treatment for toxoplasmosis. Biopsy of the IML is only considered if there is no response to treatment after 10 -14 days_ Whether such an algorithm would be applicable to the local population is unknown.
Objective. We undertook a prospective study to determine the type and frequency of IML in local HIV-seropositive patients, A secondary objective, based on the findings, was to develop a local algorithm of management.
Patients and Methods. Over a 17-month period HIVseropositive individuals with an IML were entered into the study_ Biopsy or aspiration of the lesion was performed either stereotactically or free-hand. TISSue obtained was processed 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 was similar to that in developed countries. The management protocol used elsewhere was therefore adopted for local patients.
Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it [forthcoming].
Material submitted for publication in the SAMJ is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement. The SAMJ does not hold itself responsible for statements made by the authors.
Previously published images
If an image/figure has been previously published, permission to reproduce or alter it must be obtained by the authors from the original publisher and the figure legend must give full credit to the original source. This credit should be accompanied by a letter indicating that permission to reproduce the image has been granted to the author/s. This letter should be uploaded as a supplementary file during submission.