Brain Lesions Associated with Human Immunodeficiency Virus Infection in the Antiretroviral Therapy Era: A Single-center Experience in Japan.

This study aimed to describe the clinical characteristics of patients with human immunodeficiency virus-related brain lesions who underwent neurosurgical procedures in the antiretroviral therapy era. We retrospectively analyzed 27 neurosurgical procedures in 23 patients with human immunodeficiency virus from January 2013 to December 2023. The mean ages at human immunodeficiency virus diagnosis and surgery were 46.2 ± 12.7 years and 50.8 ± 13.8 years, respectively. At human immunodeficiency virus diagnosis, 18 patients (78.3%) met the criteria for acquired immunodeficiency syndrome, and 11 (47.8%) had a cluster of differentiation 4 count of <50 cells/μL. In total, 16 lesions were diagnosed as an acquired immunodeficiency syndrome-defining illness, including primary central nervous system lymphoma (n = 10), and 11 were diagnosed as a non-acquired immunodeficiency syndrome-defining illness. The mean viral load at surgery was higher in the acquired immunodeficiency syndrome-defining illness group (6.1 ± 11.9 × 105 copies/mL) than in the non-acquired immunodeficiency syndrome-defining illness group (1.2 ± 2.8 × 105 copies/mL, p = 0.009). The time from human immunodeficiency virus diagnosis to surgery was shorter in the acquired immunodeficiency syndrome-defining illness group (7.0 ± 25.2 months vs. 50.6 ± 63.8 months, p = 0.003). A significantly greater number of patients with non-acquired immunodeficiency syndrome-defining illness than acquired immunodeficiency syndrome-defining illness had been treated with antiretroviral therapy for >3 months (72.7% vs. 12.5%, respectively; p = 0.003). The introduction of antiretroviral therapy appears to have contributed to a decrease in brain lesions diagnosed as acquired immunodeficiency syndrome-defining illness, with a corresponding increase in those diagnosed as non-acquired immunodeficiency syndrome-defining illness.