The brain in AIDS: some observations on CT scan

Abstract

The incidence and severity of the HIV epidemic varies widely in various regions resulting from variations in risk behavior, duration of disease and the availability of treatment. HIV is highly neurotropic and crosses the blood brain barrier at an early stage in the disease process. Thus the CNS is a major target of HIV with approximately 2/3 of the patients developing CNS involvement during the course of the disease. The incidence of sub clinical neurological disease is even higher; autopsy studies of patients with advanced HIV disease have demonstrated pathological abnormalities of the nervous system in 7590% of the cases 1,2. Though the availability of HAART has been associated with a dramatic decline in the incidence and severity of opportunistic infection in CNS, in developing poor countries where health resources are limited, the disease pattern is complex and diseases of the CNS remain a dominant cause of morbidity and mortality in AIDS patients. Poverty, inability to afford the treatment, inadequate diagnostic facilities,treatment and monitoring etc. are very straightforward underlying factors. Many advances in laboratory diagnostic techniques have increased the ability to make a specific diagnosis; however a large part of the diagnostic process still relies on radiological examination. MRI is the best possible choice of imaging technique. In poor countries like Zambia where MRI scan is unavailable, CT allows it to remain a first line screening tool prior to lumbar puncture or any other invasive investigation.