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Approach to HIV-infected patients with central nervous system lesions

Igor J Koralnik, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The evaluation and management of the HIV-infected patient who presents with a change in mental status or abnormal neurologic examination is a challenging problem. Patients often have lesions on computed tomography (CT) scan or magnetic resonance imaging (MRI), which may represent life-threatening emergencies depending upon their size and location.

The most important factor in determining the differential diagnosis is the degree of immunosuppression in the host.

In patients with CD4 cell counts >500/microL, benign and malignant brain tumors and metastases predominate, as in immunocompetent hosts.

In moderately immunosuppressed patients with CD4 cell counts from 200 to 500/microL, HIV-associated cognitive and motor disorders are common, but usually do not present with focal lesions.

CNS mass lesions are most common in severely immunosuppressed patients with CD4 cell counts <200/microL. The most likely diagnostic considerations include opportunistic infections (OIs) and AIDS-associated tumors, such as primary central nervous system lymphoma.

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Literature review current through: Nov 2017. | This topic last updated: Feb 09, 2017.
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