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Central Nervous System Opportunistic Infections in HIV-1 Infection

Published online by Cambridge University Press:  07 November 2014

Mauricio Concha  and
Alejandro Rabinstein
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Abstract

Neurologic disease is commonly encountered in the population infected with human immunodeficiency virus type 1 (HIV-1). Although HIV-1 is responsible for many of these neurologic complications, other organisms will affect the nervous system as the immune deficiency state progresses. With the wide use of potent antiretroviral therapy, the mortality from and incidence of opportunistic infections (OIs) among persons with advanced HIV-1 infection has decreased. Nevertheless, these diseases are still seen frequently, especially among those with limited access to new antiretroviral therapies. Therefore, it remains important to recognize the most common OIs of the central nervous system (CNS) as well as primary CNS lymphoma, which will be the focus of this review.

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Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 4: HIV and the Central Nervous System: Part One , April 2000 , pp. 43 - 60
Copyright
Copyright © Cambridge University Press 2000

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References

REFERENCES

1.Brodt, HR, Kamps, BS, Gute, P, Knupp, B, Staszewski, S, Helm, EB. Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy. AIDS. 1997;11:1731–1738.Google Scholar
2.Carpenter, CC, Fischl, MA, Hammer, SM, et al.Antiretroviral therapy for HIV infection in 1998: updated recommendations of the International AIDS Society-USA Panel. JAMA. 1998;280:78–86.Google Scholar
3.Palella, FJJ, Delaney, KM, Moorman, AC, et al.Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection: HIV-1 Outpatient Study Investigators. N Engl J Med. 1998;338:853–860.Google Scholar
4.Moore, RD, Keruly, JC, Chaisson, RE. Effectiveness of combination antiretroviral therapy in clinical practice (abstract). Presented at: The Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28–October 1, 1997; Toronto, Canada.Google Scholar
5.Price, R, Brew, B. Central and peripheral nervous system complications. In: De Vita, V, Hellman, S, Rosemberg, S, eds. AIDS: Biology, Diagnosis, Treatment and Prevention. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1997:331.Google Scholar
6.Bancellar, H, Munoz, A, Miller, EN, et al.Temporal trends in the incidence of HIV related neurologic diseases: multicenter AIDS Cohort Study, 1985-1992. Neurology. 1994;44:1892.Google Scholar
7.Luft, BJ, Hafner, R, Korzun, AH, et al, for the ACTG 077p/ANRS 009 Study Team. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1993;329:995–1000.Google Scholar
8.Porter, SB, Sande, MA. Toxoplasmosis of the central nervous system in acquired immunodeficiency syndrome. N Engl J Med. 1992;327:1643–1648.Google Scholar
9.Renold, C, Sugar, A, Chave, J-P, et al.Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Medicine. 1992;71:224–239.Google Scholar
10.DeBiasi, R, Tyler, K. Polymerase chain reaction in the diagnosis and management of central nervous system infections. Arch Neurol. 1999;56:1215–1219.Google Scholar
11.Quality Standards Subcommitee of the American Academy of Neurology. Evaluation and management of intracranial mass lesions in AIDS. Neurology. 1998;50:21–26.Google Scholar
12.Quality Standards Subcommittee of the American Academy of Neurology. Evaluation and management of intracranial mass lesions in AIDS. Neurology. 1998;50:21–26.Google Scholar
13.Holloway, RG, Mushlin, AI. Intracranial mass lesions in AIDS using decision analysis to determine the effectiveness of stereotactic brain biopsy. Neurology. 1996;46:1010–1015.Google Scholar
14.Wright, D, Chneider, A, Berger, J. Central nervous system opportunistic infections. Neuroimaging Clin N Am. 1997;7:513–525.Google Scholar
15.Garder, HA, Martinez, AJ, Visvesvara, GS, Sotrel, A. Granulomatous amebic encephalitis in an AIDS patient. Neurology. 1991;41:1993–1995.Google Scholar
16.Del Castillo, M, Mendoza, G, Oviedo, J, et al.AIDS and Chagas' disease with a central nervous system tumor-like lession. Am J Med. 1990;88:693–694.Google Scholar
17.Powderly, WG. Cryptoccocal meningitis and AIDS. Clin Infect Dis. 1993;17:837–842.Google Scholar
18.Chuck, SL, Sanda, MA. Infections with Cryptoccocus neoformans in the acquired immunodeficiency syndrome. N Engl J Med. 1989;321:794–799.Google Scholar
19.Pons, VG, Jacobs, RA, Hollander, H. Nonviral infections of the central nervous system in patients with acquired immunodeficiency syndrome. In: Rosenblum, ML, Levy, RM, Bredsen, DE, eds. AIDS and the Central Nervous System. New York, NY: Raven Press; 1998:263–283.Google Scholar
20.Polis, MA, Kovocs, JA. Fungal infections in patients with the acquired immunodeficienncy syndrome. In: De Vita, V, Hellmon, S, Rosenberg, S, eds. AIDS: Biology, Diagnosis, Treatment and Prevention. 4th ed. Philadelphia, Pa: Lippncott-Raven; 1997:231.Google Scholar
21.Andreula, CF, Burdi, N, Carella, A. CNS cryptoccocosis in AIDS: spectrum of MR findings. J Comput Assist Tomogr. 1993;17:438.Google Scholar
22.Van der Horst, C, Saag, M, Cloud, G, et al.Treatment of cryptoccocal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med. 1997;337:15–21.Google Scholar
23.Powderly, WG, Cloud, GA, Dismukes, WE, et al.Measurement of cryptococcal antigen in serum and cerebrospinal fluid: value in the management of AIDS-associated cryptococcal meningitis. Clin Infect Dis. 1994;18:789–792.Google Scholar
24.Darras-Joly, C, Chevret, S, Wolff, M, et al.Cryptoccocus neoformans infection in France: epidemiologic features of and early prognostic parameters for 76 patients who were infected with HIV-1. Clin Infect Dis. 1996;23:369–376.Google Scholar
25.Carraza, RJ, Rossitch, E Jr, Morris, J. Isolated central nervous system aspergillosis in AIDS. Clin Infect Dis. 1991;93:227–230.Google Scholar
26.Cuadrado, LM, Guerrero, A, Lopez Garcia Asenjo, JA, et al.Cerebral mucormycosis in two cases of the acquired immunodeficiency syndrome. Arch Neurol. 1988;45:109–111.Google Scholar
27.Wheat, LJ, Connolly-Stringfield, PA, Baker, RL, et al.Disseminated histoplasmosis in AIDS: clinical findings, diagnosis and treatment and review of the literature. Medicine. 1990;69:361–374.Google Scholar
28.Fish, DG, Ampel, NM, Galgiani, JN, et al.Coccidioidomycosis during human immunodeficiency virus infection: a review of 77 patients. Medicine. 1990;69:384–391.Google Scholar
29.Gade, W, Ledman, DW, Wethington, R, Yi, A. Serological responses to various coccidiodes antigen preparations in a new enzyme immunoassay. J Clin Microbiol. 1992;39:1907–1912.Google Scholar
30.Berger, JR. Neurosyphilis in human immunodeficiency virus type-1–seropositive individuals: a prospective study. Arch Neurol. 1991;48:700–702.Google Scholar
31.Scheck, DN, Hook, EW. Neurosyphilis. Infect dis clin North Am. 1994;8:764–795.Google Scholar
32.Musher, DM, Hamill, RJ, Baughn, RD. Effect of HIV-1 infection on the course of syphilis and on the response to treatment. Ann Intern Med. 1990;113:872–881.Google Scholar
33.Marra, CM. Neurosyphilis. In: Johnson, RT, Griffin, JW, eds. Current Therapy in Neurologic Disease. 5th ed. St Louis, Mo: Mosby-Year Book. 1997.Google Scholar
34.Feraru, ER, Aronow, HA, Lipton, RB. Neurosyphilis in AIDS patients: initial CSF VDRL may be negative. Neurology. 1990;40:541–543.Google Scholar
35.Haas, JS, Bolan, G, Larsen, SA, et al.Sensitivity of treponemal tests for detecting prior treated syphilis during HIV-1 infection. J Infect Dis. 1990;162:862–866.Google Scholar
36.Harrison, M, McArthur, J. Opportunistic infections-bacteria. In: AIDS and Neurology. New York, NY: Churchill Livingstone; 1995:151–170.Google Scholar
37.Havlir, D, Barnes, P. Tuberculosis in patients with HIV-1 infection. N Engl J Med 1999;340:367–373.Google Scholar
38.Whalen, C, Horsburgh, CR, Hom, D, et al.Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Care Med. 1995;151:129–135.Google Scholar
39.Villoria, MF, de la Torre, J, Munoz, , et al.Intracranial tuberculosis in AIDS: CT and MRI findings. Neuroradiology. 1992;34:11–14.Google Scholar
40.Zuger, A, Lowdy, FD. Tuberculosis. In: Scheld, WM, Whitley, RJ, Durack, DT, eds. Infections of the Central Nervous System. 2nded. Philadelphia, Pa: Lippincott-Raven; 1997:417.Google Scholar
41.Dube, MP, Holon, PD, Larsen, RA. Tuberculosis meningitis in patients with and without human immunodeficiency virus infection. Am J Med. 1992;93:520–524.Google Scholar
42.Kent, SJ, Crowe, SM, Yung, A, Lucas, R, Mijch, AN. Tuberculosis meningitis: a 30-year review. Clin Infect Dis. 1993;17:987–994.Google Scholar
43.Kennedy, DH, Fallon, RJ. Tuberculous meningitis. JAMA. 1979;241:264–268.Google Scholar
44.Whiteman, ML. Neuroimaging of central nervous system tuberculosis in HIV-infected patients. In: Neuroimaging clin North Am. Post, M. Judith (ed.). 1997;7:199–214.Google Scholar
45.Pulido, F, Pena, J-M, Rubio, R, et al.Relapse of tuberculosis after treatment in HIV-1–infected patients. Arch Intern Med. 1997;157:227–232.Google Scholar
46.Shafer, RWChirgwin, KD, Glatt, AE, et al.HIV prevalence, immunosuppression and drug resistance in patients with tuberculosis in an area endemic for AIDS. AIDS. 1991;5:399–405.Google Scholar
47.Bartlett, JG. Medical Management of HIV Infection. Physicians & Scientists Publishing Co. GlenviewF; 1996.Google Scholar
48.Centers for Disease Control and Prevention. Prevention and treatment of tuberculosis among patients infected with HIV-1: principles of therapy and revised recommendations. MMWR. 1998;47(RR-20):1–58.Google Scholar
49.Jacob, CN, Henein, SS, Heurich, AE, Kamholtz, S. Nontuberculous mycobacterial infection of the central nervous system in patients with AIDS. South Med J. 1993;106:333–304.Google Scholar
50.Hadley, MN, Spetzler, RF, Martin, NA, Johnson, PC. Middle cerebral artery aneurysm due to nocardia asteroides: case report of aneurysm excision and extracranial-intracranial bypass. Neurosurgery. 1988;22:923–928.Google Scholar
51.Whiteman, ML, Post, MJ, Sklar, EML. Neuroimaging of acquired immunodeficiency syndrome. In: Berger, JR, Levy, RM, eds. AIDS and the nervous system. 2nd edition. Philadelphia, Pa: Lippincott-Raven Publishers; 1997Google Scholar
52.Decker, CF, Simon, GL, DiGiola, RA, et al.Listeria monocytogenes infections in patients with AIDS: report of five cases and review. Rev Infect Dis. 1991;13:A13–17.Google Scholar
53.Berenguer, J, Solera, J, Diaz, et al.Listeriosis in patients infected with human immunodeficiency virus. Rev Infect Dis. 1991;13:115–119.Google Scholar
54.Kales, CP, Holzman, RS. Listeriosis in patients with HIV infection: clinical manifestations and responses to therapy. J Acquir Immune Defic Syndr. 1992;3:139–143.Google Scholar
55.Richardson, EP Jr. Progressive multifocal leukoencephalopathy 30 years later. N Engl J Med. 1988;318:315–316.Google Scholar
56.Major, EO, Amemiya, K, Tornatore, C, Houff, S, Berger, JR. Pathogenesis and molecular biology of progressive multifocal leukoencephalopathy, the JC virus-induced demyelinating disease of the human brain. Clin Microbiol Rev. 1992;5:49–73.Google Scholar
57.Gibson, PE, Field, AM, Gardner, SD, et al.Occurrence of IgM antibodies against BK and JC polyomaviruses during pregnancy. J Clin Pathol. 1981;34:674–679.Google Scholar
58.Shah, KV. Polyomaviruses. In: Fields, BN, Knipe, DM, et al, eds. Virology. Vol 2. New York, NY: Raven Press; 1990:1609–1623.Google Scholar
59.Taguchi, F, Kajioka, J, Miyamura, T. Prevalence rate and age of acquisition of antibodies against JC virus and BK virus in human sera. Microbiol Immunol. 1982;26:1057–1064.Google Scholar
60.Padgett, BL, Walker, DL. Virologic and serologic studies of progressive multifocal leukoencephalopathy. In: Sever, J, Madden, DL, eds. Polyomaviruses and Human Neurological Disease. New York, NY: Alan R. Liss; 1983.Google Scholar
61.Brooks, BR, Walker, DL. Progressive multifocal leukoencephalopathy. Neurol Clin. 1984;2:299–313.Google Scholar
62.Berger, JR, Concha, M. Progressive multifocal leukoencephalopathy: the evolution of a disease once considered rare. J Neurovirol. 1995;1:5–18.Google Scholar
63.Kuchelmeister, K, Gullotta, F, Bergmann, M. Progressive multifocal leukoencephalopathy (PML) in the acquired immunodeficiency syndrome (AIDS): a neuropathological autopsy study of 21 cases. Pathol Res Pract. 1993;189:163–173.Google Scholar
64.ZuRhein, GM. Polyoma-like virions in a human demyelinating disease. Acta Neurol Pathol. 1967;8:57–68.Google Scholar
65.Whiteman, M, Post, MJD, Berger, JR, Limonte, L, Tate, LG, Bell, M. PML in 47 HIV-1+ patients. Radiology. 1993;187:233–240.Google Scholar
66.Chang, L, Ernst, T, Tornatore, C, et al.Metabolite abnormalities in progressive multifocal leukoencephalopathy by proton magnetic resonance spectroscopy. Neurology. 1997;48:836–845.Google Scholar
67.McGuire, D, Barhite, S, Hollander, H, Miles, M. JC virus DNA in cerebrospinal fluid of human immunodeficiency virus-infected patients: predictive value for progressive multifocal leukoencephalopathy. Ann Neurol. 1995;37:395–399.Google Scholar
68.Berger, JR, Mucke, L. Prolonged survival and partial recovery in AIDS-associated progressive multifocal leukoencephalopathy. Neurology. 1988;38:1060–1065.Google Scholar
69.Berger, JR, Levy, RM, Flomenhoft, D, Dobbs, M. Predictive factors for prolonged survival in AIDS-associated PML [abstract]. J neurovirol 1998;4:342.Google Scholar
70.Hall, CD, Daml, U, Simpson, D, et al.Failure of cytarabine in progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection: AIDS Clinical Trial Group 243 Team. N Engl J Med. 1998;338:1345–1351.Google Scholar
71.Costagiola, D. Clinical manifestations of HIV-1 infections in the era of highly active antiretroviral treatment (HAART) in France (abstract). Presented at: 12th World AIDS Conference; June 28–July 3, 1998; Geneva, Switzerland.Google Scholar
72.Clifford, DB, Yiannoutsos, C, Glicksman, M, et al.HAART improves prognosis in HIV-1–associated progressive multifocal leukoencephalopathy. Neurology. 1999;52:623–625.Google Scholar
73.Dubois, V, Barbeau, P, Lafon, ME, Pellegrin, JL, Fleury, H. JCV, DNA, and mRNA sequential detection in a patient presenting long term remission of PML [abstract]. J Neurovirol. 1998;4:347.Google Scholar
74.Giudici, B, Vaz, B, Bossolasco, S, et al.Clearance of JC virus (JCV)-DNA from the cerebrospinal fluid of patients with progressive multifocal leukoencephalopathy (PML) after triple antiretroviral therapy [abstract]. J Neurovirol. 1998;4:352.Google Scholar
75.De Luca, A, Ammassari, A, Cingolani, A, et al.Disease progression and poor survival of AIDS-associated progressive multifocal leukoencephalopathy despite highly active antiretroviral therapy. AIDS. 1998;12:1937–1938.Google Scholar
76.Meylan, PR, Vuadens, P, Maeder, P, Sahli, R, Tagan, MC. Monitoring the response of AIDS-related progressive multifocal leukoencephalopathy to HAART and cidofovir by PCR for JC virus DNA in CSF. Eur Neurol. 1999;41:172–174.Google Scholar
77.Oliveira, ACP, Pereira, LC Jr, Bonasser, F. Treatment for progressive multifocal leukencephalopathy with cidofovir: a case report [abstract]. J Neurovirol. 1998;4:361.Google Scholar
78.Huang, SS, Skolasky, RL, Dal Pan, GJ, Royal, W, McArthur, J. Survival prolongation in HIV-1–associated progressive multifocal leukoencephalopathy treated with alpha-interferon: an observational study. J Neurovirol. 1998;4:324–332.Google Scholar
79.Snapka, R. Topoisomerase inhibitors can selectively interfere with different stages of simian virus 40 DNA replication. Mol Cell Biol. 1986;6:4221–4227.Google Scholar
80.Rubenstein, L, Rein, A. Effect of campothecin on simian virus 40 DNA. Nature. 1973;248:226–228.Google Scholar
81.Kerr, DA, Chang, CF, Gordon, J, et al.Inhibition of human neurotropic virus (JCV) DNA replication in glial cells by campothecin. Virology. 1993;196:612–618.Google Scholar
82.Blaney, S, Cole, D, Balis, F, Goodwin, K, Poplack, D. Plasma and cerebrospinal fluid pharmadinetic study of topotecan in nonhuman primates. Cancer Res. 1993;53:725–727.Google Scholar
83.Drew, WL. Cytomegalovirus infection in patients with AIDS. J Infect Dis. 1998;158:449–456.Google Scholar
84.Leach, CT, Cherry, JD, English, PA, et al.The relationship between T-cell levels and CMV infection in asymptomatic HIV-1-1 antibody-positive homosexual men. J Acquir Immune Defic Syndr. 1993;6:407–413.Google Scholar
85.Cohen, B, Dix, RD. Cytomegalovirus and other herpesvirus. In: Berger, JR, Levy, RM, eds. AIDS and the Nervous System. 2nd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1997.Google Scholar
86.Cheong, I, Flegg, PJ, Brettle, RP, et al.Cytomegalovirus disease in AIDS: the Edinburgh experience. Int J STD AIDS. 1992;3:324–328.Google Scholar
87.Degans, J, Portegies, P. Neurological complications of infections with human immunodeficiency virus type 1: a review of literature and 241 cases. Clin Neurol Neurosurg. 1989;91:199–219.Google Scholar
88.Holland, NR, Power, C, Mathews, VP, Glass, JD, Forman, M, McArthur, JC. CMV encephalitis in acquired immunodeficiency syndrome (AIDS). Neurology. 1994;44:507–514.Google Scholar
89.Arribas, JR, Storch, GA, Clifford, D, Tselis, A. Cytomegalovirus encephalitis. Ann Intern Med. 1996;125:577–587.Google Scholar
90.Cinque, P, Vago, L, Dahl, H, et al.Polymerase chain reaction on cerebrospinal fluid for diagnosis of virus-associated opportunistic diseases of the central nervous system in HIV-1–infected patients. AIDS. 1996;10:951–958.Google Scholar
91.Bazan, C, Jackson, C, Jinkins, JR, Barohn, RJ. Gadolinium-enhanced MRI in a case of cytomegalovirus polyradiculopathy. Neurology. 1991;41:1522–1523.Google Scholar
92.So, Y, Olney, R. Acute Lumbrosacral polyradiculopathy in AIDS: experience in 23 patients. Ann Neurol. 1994;35:53–58.Google Scholar
93.Peters, M, Timm, U, Schurmann, D. Combined and alternating ganciclovir and foscarnet in acute and maintenance therapy of human immunodeficiency virus-related cytomegalovirus encephalitis refractory to ganciclovir alone. Clinical Investigator. 1992;70:456–458.Google Scholar
94.Tucker, T, Dix, RD, Katzen, C, Davis, RL, Schmidley, JW. Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome. Ann Neurol. 1985;18:74–79.Google Scholar
95.Lipton, SA, Schaefer, PW, Adams, RD, Ma, MJ. A 37 year old man with AIDS, neurologic deterioration, and multiple hemorrhagic cerebral lesions: varicella-zoster leukoencephalitis with hemorrhage and large-vessel vasculopathy—acquired immunodeficiency syndrome. N Engl J Med. 1996;335:1587–1595.Google Scholar
96.Petito, CK, Cho, E-S, Lemann, W, Navia, BA, Price, RW. Neuropathology of acquired immunodeficiency syndrome (AIDS): an autopsy review. J Neuropathol Exp Neurol. 1986;45:635–646.Google Scholar
97.Gray, F, Mohr, M, Rozenberg, F, et al.Varicellazoster virus encephalitis in acquired immunodeficiency syndrome: report of four cases. Neuropathol Appl Neurobiol. 1992;18:502–514.Google Scholar
98.Schmidbauer, M, Budka, H, Ambros, P. Herpes simplex virus (HSV) DNA in microglial nodular Varicella zoster virus infection in nervous tissues. Brain. 1992;115:383–398.Google Scholar
99.Chetien, F, Gray, F, Lescs, MC, et al.Acute varicella-zoster virus ventriculitis and meningo-myelo-radiculitis in acquired immunodeficiency syndrome. Acta Neuropathol. 1993;86:659–665.Google Scholar
100.McCullers, JA, Lakeman, FD, Whitley, RJ. Human herpesvirus 6 is associated with focal encephalitis. Clin Infect Dis. 1995;21:571–576.Google Scholar
101.Lakeman, FD, Whitley, RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. J Infect Dis. 1995;171:857–863.Google Scholar
102.Balfour, HH Jr, Bean, B, Laskin, OL. Acyclovir halts progression of herpes zoster in immunocompromised patients. N Engl J Med. 1983;308:1448–1453.Google Scholar
103.Levine, AM, Sullivan-Halley, J, Pike, MC, et al.Human immunodeficiency virus-related lymphoma—prognostic factors predictive of survival. Cancer. 1991;68:2466–2472.Google Scholar
104.Ruiz, A, Post, MJD, Bundschu, C, Ganz, WI, Georgiou, M. Primary central nervous system lymphoma in patients with AIDS. In: Post, MJ, ed. Neuroimaging Clinics of North America. 1997;7:281–296.Google Scholar
105.Straus, DI. HIV associated lymphomas. Curr Opin Oncol. 1997;9:450–454.Google Scholar
106.MacMahon, E, Glass, JD, Hayward, SD, et al.Epstein-Barr virus in AIDS-related primary central nervous system lymphoma. Lancet. 1991;338:969–973.Google Scholar
107.Liebowitz, D. Epstein-Barr virus and a cellular signaling pathway in lymphomas from immuno-suppressed patients. N Engl J Med. 1998;338:1413–1421.Google Scholar
108.Remick, SC, Diamond, C, Migiozz, J, et al.Primary central nervous system lymphoma in patients with and without the acquired immune deficiency syndrome. Medicine. 1990;69:345–360.Google Scholar
109.Levy, RM, Russell, E, Yungbluth, M, Hidvegi, DF, Brody, BA, DalCanto, MC. Efficacy of image guided stereotactic biopsy in neurologically symptomatic acquired immunodeficiency syndrome patients. Neurosurgery. 1992;30:186–190.Google Scholar
110.Chamberlain, MC. Long survival in patients with acquired immune deficiency syndrome-related primary central nervous system lymphoma. Cancer. 1994;73:1728–1730.Google Scholar