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Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients
  1. Ashley M Lee1,
  2. Harrison X Bai2,
  3. Yingjie Zou1,
  4. Dongxu Qiu1,
  5. Jianhua Zhou3,
  6. Maria Martinez-Lage Alvarez4,
  7. Paul Zhang4,
  8. Yongguang Tao5,
  9. Xiangqi Tang2,
  10. Bo Xiao6,
  11. Li Yang1
  1. 1Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
  2. 2Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Department of Pathology, The First Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
  4. 4Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5Cancer Research Institute of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
  6. 6Department of Neurology, The First Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
  1. Correspondence to Dr Li Yang, Department of Neurology, The Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha 410011, Hunan, People's Republic of China; yangli762{at}gmail.com Dr Bo Xiao, The first Xiangya Hospital, Central South University, No 87 Xiangya Road, Changsha, 410008, Hunan, People' Republic of China; xiaobo1962xy{at}163.com

Abstract

Early brain biopsy may be indicated in HIV patients with focal brain lesion. This study aimed to evaluate and compare the safety and diagnostic value of brain biopsy in HIV patients in the pre-highly active antiretroviral therapy (HAART) versus post-HAART era via meta-analysis. Appropriate studies were identified per search criteria. The local database was retrospectively reviewed to select a similar patient cohort. Patient demographics, brain biopsy technique, histopathology and patient outcomes were extracted from each study. Study-specific outcomes were combined per random-effects model. Outcomes were compared between the pre-HAART and post-HAART era. Correlations between outcomes and baseline characteristics were assessed via meta-regression analysis. The proportions of histopathological diagnosis were tabulated and compared between the pre- and post-HAART era. Survival analysis was performed for patients in the post-HAART era. A total of 26 studies (including the local database) with 1209 patients were included in this meta-analysis. The most common indications for brain biopsy were diagnosis unlikely to be toxoplasmosis (n=8, 42.1%), focal brain lesion (n=5, 26.3%) or both (n=3, 15.8%). The weighted proportions for diagnostic success were 92% (95% CI 90.0% to 93.8%), change in management 57.7% (45.9% to 69.1%) and clinical improvement 36.6% (26.3% to 47.5%). Morbidity and mortality were 5.7% (3.6% to 8.3%) and 0.9% (0.3% to 1.9%), respectively. Diagnostic success rate was significantly higher in the post-HAART than the pre-HAART era (97.5% vs 91.9%, p=0.047). The odds ratio (OR) for diagnostic success in patients with contrast-enhanced lesions was 2.54 ((1.25 to 5.15), p<0.01). The median survival for HIV patients who underwent biopsy in the post-HAART era was 225 days (90–2446). Brain biopsy in HIV patients is safe with high diagnostic yield. Early brain biopsy should be considered in patients without classic presentation of toxoplasmosis encephalitis.

  • AIDS
  • INFECTIOUS DISEASES
  • PATHOLOGY

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