Radiation semiotics of brain lesions in HIV-infection with regard to immune status and antiretroviral therapy
Objective is to describe a radiation semiotics of brain lesions depending on immunosuppression state caused by HIV-infection and HIV replication activity. Methods: We analyzed results of a complex X-Ray examination of 300 HIV-infected adult patients who underwent magnetic resonance imaging (MRI) of the brain. All patients were divided into groups depending on status of antiretroviral therapy (ARVT), amount of CD4-lymphocytes in the blood, and on detected brain lesions. Patients with the immune reconstitution inflammatory syndrome (IRIS) were placed in a separate group. Results: Symptoms of HIV-encephalopathy were detected in more than a half of patients. We identified a wide range of coinfections and opportunistic diseases with brain damage. With development of immunosuppression we recorded the increase in number of focal and diffuse central nervous system. At IRIS new lesions appeared and old lesions increased in size in the brain; the confluent pattern of changes was recorded up to generalization. IRIS was associated either with beginning of ARVT or with its resumption after a break, and symptoms of abnormal progressive multifocal leukoencephalopathy were significantly more frequently visualized. Conclusions: Atrophic changes, focal and diffuse brain lesions were detected in most patients with HIV-infection. Large foci were more common in cases without ARVT, perifocal edema and contrast uptake in the area of changes of central nervous system were detected, changes increased with the progression of immunosuppression. The main distinguishing radiation symptom of brain damage in IRIS was acute inflammatory demyelination. It is rationale to expand indications and conditions to conduct radiological examination of the brain in cases of suspected pathological process or in primary symptoms of cognitive or neuropsychological disorders in patients with HIV-infection.