Human immunodeficiency virus (HIV) is a global health problem. It renders the central nervous system susceptible to infectious and noninfectious diseases. HIV-positive individuals may present to neurosurgical services with brain lesions of unknown etiology. The differential diagnosis in these cases is broad, including opportunistic infections and malignancies, and investigation should be tailored accordingly. Opportunistic infections of the central nervous system can be complicated by hydrocephalus, and the management is pathogen dependent. Patients may also present to a neurosurgical service with conditions unrelated to their HIV status. This review outlines important conditions that cause brain lesions and hydrocephalus. It addresses the issues of diagnosis and intervention in HIV-positive patients in the era of combination antiretroviral therapy, while not ignoring the potential for opportunistic central nervous system infection in undiagnosed patients. The care of HIV-positive patients presenting to neurosurgical services requires a multidisciplinary approach, which is reflected in the authorship of this review, as well as in the guidance given.
Keywords: EBV = Epstein-Barr virus; IRIS = immune reconstitution inflammatory syndrome; JC = John Cunningham; LP = lumbar puncture; PCNSL = primary CNS lymphoma; PCR = polymerase chain reaction; PEP = postexposure prophylaxis; PML = progressive multifocal leukoencephalopathy; PPV = positive predictive value; RR = relative risk; TB-IRIS = tuberculosis-associated IRIS; TBM = tuberculous meningitis; VP = ventriculoperitoneal; cART = combination antiretroviral therapy; human immunodeficiency virus; immune reconstitution inflammatory syndrome; infection; neuroradiology; neurosurgery; primary CNS lymphoma; progressive multifocal leukoencephalopathy.