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Q J Med 2004; 97: 413-421
QJM vol. 97 no. 7 © Association of Physicians 2004; all rights reserved.

Management of HIV-associated focal brain lesions in developing countries

M. Modi1, A. Mochan2 and G. Modi2

From the 1Division of Radiology, Department of Radiation Sciences, and 2Division of Neurology, Department of Neurosciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Received 28 October 2003 and in revised form 5 April 2004

Background: HIV-associated focal brain lesions (HFBL) 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 however are poorly suited to developing countries, where treatable infections predominate as causes of HFBL.

Aim: To determine a practical approach to the management of HFBL in developing countries.

Design: Case series.

Methods: Patients (n = 32) were managed based on presumed aetiologies of the focal brain lesions, determined by collating information from CT scans, CSF and blood studies, concurrent non-neurological illness and response to treatment.

Results: The principal presumed cause of HFBL was tuberculosis (69%). The therapeutic response was good in 69% of patients.

Discussion: In developing countries, infections are the predominant cause of HFBL, the principal causes being infections that are endemic to the populations being studied. Empiric treatment based on limited investigations should be directed according to the nature of such infections. A modified algorithm is proposed.

Address correspondence to Professor G. Modi, P.O. Box 909, Lenasia 1820, South Africa. e-mail: gmodicns{at}mweb.co.za


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