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EDITORIAL Table of Contents   
Year : 2003  |  Volume : 13  |  Issue : 4  |  Page : 367-369
HIV and the changing role of radiologist


Editor-in-chief, The Indian Journal of Radiology and Imaging, India

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How to cite this article:
Desai SB. HIV and the changing role of radiologist. Indian J Radiol Imaging 2003;13:367-9

How to cite this URL:
Desai SB. HIV and the changing role of radiologist. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Jul 22];13:367-9. Available from: http://www.ijri.org/text.asp?2003/13/4/367/28709
The growing epidemic of HIV in India is a matter of concern to the entire health care industry and the policy makers. The WHO estimates that there are nearly 1.5 million people infected with HIV in India. The increasing number of HIV sero-positive cases that we see in our daily practice, most without a confirmed diagnosis at the time of imaging, make two issues very important; one that we should follow Universal Precautions in every patient and two that we must alert the referring physician and raise the possibility of immuno-suppression if the imaging findings suggest it.

The various CNS diseases that we see frequently in our practice amongst HIV infected individuals include HIV encephalopathy [Figure - 1], progressive multifocal leukoencephalopathy [Figure - 2], infections like tuberculosis and toxoplasmosis [Figure - 3]. In addition, HIV vasculitis and cryptococcal infection [Figure - 4] is also encountered. The imaging features of all these diseases are well described in literature. We have found the presence of bleed within a ring-enhancing lesion to be highly specific for toxoplasmosis. Tuberculous arteritis is also more common with tuberculous meningitis in HIV infected individuals. We also frequently utilize MR spectroscopy in HIV Neuroimaging especially to differentiate between toxoplasmosis and primary CNS lymphoma (which may be indistinguishable from toxoplasmosis both on signal intensity and enhancement characteristics). The latter shows an elevated choline peak while the former shows a lactate-lipid peak on MR spectroscopy [Figure - 5],[Figure - 6]. Another important entity in HIV Neuroimaging that we must all be familiar with, especially with anti-retroviral therapy becoming accessible to people, is the immune reconstitution syndrome. Once the diagnosis of HIV is made and HAART therapy instituted, there may be a flare up or development of new pathologies in a patient. This occurs due to the improving CD4 count and better host response to organisms. This should not alarm the radiologist. It should not be considered as inaccurate diagnosis or failure of institution of appropriate therapy.

Pneumocystis carini pneumonia is the most frequently encountered chest infection in HIV/AIDS. Imaging can play a crucial role in making the diagnosis, as the findings on HRCT are classical [Figure - 7] obviating the need for any invasive procedure. Atypical mycobacterial and viral (e.g. CMV) infections are also on the rise and have specific radiological features. The incidence of tuberculosis has also increased due to HIV. Multiple splenic and liver granulomas and abscesses [Figure - 8] and extensive peripancreatic tuberculosis is more common with underlying HIV disease. A predisposition to development of bursitis, and osteomyelitis may also be seen in these individuals.

HIV is truly a disease with multi- system involvement. Infection with HIV is shown to be a pro-thrombotic state. We have seen a few cases of dural sinus thrombosis and mesenteric ischemia in HIV positive patients with no other pro-thrombotic tendency. The implications of all this is tremendous; we have new emerging disease trends that we must familiarize ourselves with. The current practice of medicine is heavily imaging dependent. This increases the responsibility of the radiologist and also the medico legal liability. Varied, often geographical trends are seen with HIV. What may be true for the West may not hold true for us. For e.g. Kaposi's sarcoma is not common in our set-up. As we see more and more cases of HIV in our daily practices it becomes imperative that we interact, publish and share our experiences.

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Correspondence Address:
Shrinivas B Desai
Editor-in-chief, The Indian Journal of Radiology and Imaging
India
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Source of Support: None, Conflict of Interest: None


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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]



 

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