The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions

Article Abstract:

One of the neurologic complications of AIDS is the development of mass lesions of the brain (abnormalities that appear on brain scans as masses or tumors), a common cause of which is toxoplasmosis (an infection). However, debate exists concerning whether this diagnosis should be verified by brain biopsy before treatment starts, or whether treatment should be started based on clinical evidence (empiric therapy). Factors that affect this decision are the risks and benefits of toxoplasmosis therapy, the risks of biopsy, and the risks of delaying a diagnosis of another condition. A study was carried out of 59 patients who had brain mass lesions and risk factors for AIDS to determine how best to predict the probability that a patient had toxoplasmosis. Patients with a high probability of this disease would be candidates for empiric treatment, while those with a low probability would be candidates for biopsy. The patients' charts were reviewed and the results of diagnostic tests noted. Thirty-two patients met the diagnostic criteria for toxoplasmosis; criteria included response to therapy (21 cases), biopsy (10), or results from autopsy (5). More than one diagnostic approach was used in some cases. Of the 32 patients who underwent biopsy, only 10 had toxoplasmosis. To estimate the probability of toxoplasmosis using different independent diagnostic indicators, Bayes' theorem was used. It appeared that the effect of a positive result on a type of brain scan (computerized tomography or CT, using contrast material) increased the probability of toxoplasmosis to 0.68; if a positive result on a blood test for toxoplasmosis is included, the probability rises to 0.81. On the other hand, patients without the CT finding and negative results on the blood test have a probability of having toxoplasmosis of only 0.14. The results show that a method can be developed for estimating the probability that a person with a mass lesion who is at risk for AIDS has toxoplasmosis. Patients with typical features of the disease should be given empiric therapy, while those whose disease has less typical features are better candidates for brain biopsy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Diagnosis, Toxoplasmosis, Diagnosis, Differential, Differential diagnosis

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Cerebrospinal fluid and human immunodeficiency virus: findings in healthy, symptomatic, seropositive men

Article Abstract:

The acquired immunodeficiency syndrome (AIDS) is often complicated by neurologic or nerve-related disorders, including tumors and opportunistic infections of the central nervous system. The occurrence of neurologic syndromes in AIDS may indicate direct or indirect effects of the human immunodeficiency virus (HIV) on the central nervous system. These syndromes include peripheral nerve disease, disorders of striated muscle and the spinal cord, inflammation of the membranes of the spinal cord and brain, and dementia, or impaired intellectual function. Progressive dementia is often associated with impaired motor function and behavior and is referred to as AIDS dementia complex. The prevalence of AIDS dementia complex and its contribution to increased disease activity in patients with advanced AIDS has prompted the investigation of neuropsychiatric complications of AIDS. Abnormalities of the cerebrospinal fluid (CSF), which bathes the brain and spinal cord, were identified and characterized in 25 patients who were seropositive (tested positive) for HIV infection but lacked the associated symptoms. There was an increased incidence of CSF abnormalities in healthy seropositive men without symptoms of HIV disease. Pleocytosis, the increased number of lymphocytes, a type of white blood cell, in the CSF, or increased levels of CSF proteins, were detected in 12 patients. Oligoclonal banding, an indicator of disease activity, was identified in six of 23 patients tested and HIV was isolated from four patients. These CSF abnormalities indicate disease activity in the central nervous system occurring even in the early stages of HIV infection in patients without symptoms. These patients should be monitored for the occurrence of neuropsychiatric disorders to determine the relevance of CSF abnormalities in the early stages of HIV disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Abnormalities, Neurologic manifestations of general diseases, Neurologic manifestations, Cerebrospinal fluid

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Human immunodeficiency virus infection and the skin: a crucial interface

Article Abstract:

Although AIDS cannot be cured, recent treatment advances have enabled many AIDS patients and those infected with human immunodeficiency virus (HIV) to live longer and with fewer concomitant infections. A review is presented of the skin manifestations of HIV infection; correct diagnosis of these disorders can allow for both earlier diagnosis of HIV infection and better control of the disease. In many cases, the skin is the first organ affected by HIV infection and the primary site of infection during most of the illness. Physicians should be alert for diseases that occur in unusual settings (e.g. herpes zoster in a young person, unexplained oral candidiasis); common skin diseases that are unusually severe (widespread seborrheic dermatitis); failure to respond to routine treatments; or skin diseases that take on unusual clinical appearances. Color photographs illustrate these abnormalities. Opportunistic infections (to which a healthy person is normally immune) may manifest themselves by skin signs; typical infections and their appearances are described. A table of common skin conditions in people infected with HIV, and their treatments, is presented. While skin diseases in these patients are rarely life-threatening, they can drastically impair the quality of life. Therefore, infections in HIV-infected people should be treated persistently and creatively, even though the outcome may be less successful than in healthy people. A holistic approach that encourages stress reduction and support may be effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Skin diseases, Diseases, HIV patients, Cutaneous manifestations of general diseases, Skin manifestations

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