Safety and diagnostic value of brain biopsy in HIV patients: a case series and meta-analysis of 1209 patients
| Autor: | Bo Xiao, Maria Martinez-Lage Alvarez, Dongxu Qiu, Paul J. Zhang, Harrison X. Bai, Yongguang Tao, Ashley M. Lee, Li Yang, Xiangqi Tang, Jianhua Zhou, Yingjie Zou |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
AIDS Dementia Complex Biopsy Statistics as Topic HIV Infections Cohort Studies 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine Humans Medicine 030212 general & internal medicine Survival analysis Retrospective Studies medicine.diagnostic_test business.industry Brain biopsy Leukoencephalopathy Progressive Multifocal Brain Retrospective cohort study Odds ratio Survival Analysis Surgery Psychiatry and Mental health Treatment Outcome Toxoplasmosis Cerebral Predictive value of tests Histopathology Guideline Adherence Neurology (clinical) business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Journal of Neurology, Neurosurgery & Psychiatry. 87:722-733 |
| ISSN: | 1468-330X 0022-3050 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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