Document 0325
 DOCN  M9650325
 TI    Early biopsy versus empiric treatment with delayed biopsy of
       non-responders in suspected HIV-associated cerebral toxoplasmosis: a
       decision analysis.
 DT    9605
 AU    Mathews C; Barba D; Fullerton SC; Department of Medicine, University of
       California, San Diego, USA.
 SO    AIDS. 1995 Nov;9(11):1243-50. Unique Identifier : AIDSLINE MED/96126178
 AB    OBJECTIVE: To construct and evaluate a decision analytic model of
       proposed management strategies for HIV-infected patients presenting with
       cerebral mass lesions, radiographically compatible with toxoplasmosis,
       lymphoma, or other etiologies, assuming knowledge of Toxoplasma antibody
       status in serum. METHODS: Using decision analysis, we evaluated two
       management strategies, for patients found to be either
       Toxoplasma-seropositive or -negative, for whom an initial choice was
       made for early brain biopsy (EB) or for empiric therapy with delayed
       biopsy (ETDB) of non-responders. The outcome to be optimized was the
       percentage of patients alive at 12 months. Model variables included
       predictive value of toxoplasmosis serology, probabilities of treatment
       response and death within 14-21 days conditional on correct diagnosis,
       probability of operative death, probabilities of non-diagnostic brain
       biopsy conditional both on correct diagnosis and prior treatment.
       RESULTS: One and two-way sensitivity analyses, by Toxoplasma serostatus,
       led to the following conclusions (1) for Toxoplasma-seropositive
       patients, ETDB gives nearly equivalent outcomes to EB of all patients;
       (2) for Toxoplasma-seronegative patients, although both strategies have
       equivalent outcomes under baseline assumptions, EB is preferred if there
       are even small survival advantages for early versus delayed diagnosis of
       lymphoma or other conditions, or if risk of death within 14-21 days of
       ET exceeds 10% when correct diagnosis is not toxoplasmosis. CONCLUSION:
       Under plausible assumptions, Toxoplasma-seronegative patients will
       benefit from an early biopsy strategy.
 DE    Biopsy  *Decision Support Techniques  Human  HIV
       Infections/*COMPLICATIONS  Support, U.S. Gov't, P.H.S.  Toxoplasmosis,
       Cerebral/ETIOLOGY/*PATHOLOGY/THERAPY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).