FDG-PET imaging in HIV infection and tuberculosis

dc.contributor.authorSathekge, Mike Machaba
dc.contributor.authorMaes, Alex
dc.contributor.authorVan de Wiele, Christophe
dc.contributor.emailmike.sathekge@up.ac.zaen_US
dc.date.accessioned2013-10-23T09:56:16Z
dc.date.available2013-10-23T09:56:16Z
dc.date.issued2013-09
dc.description.abstractThe intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have global prevalence with devastatingmorbidity andmassive mortality. Using FDG-PET imaging it was shown that in HIV-infected individuals, involvement of the head and neck precedes that of the chest and of the abdomen. The sequence of lymph node involvement observed suggests the existence of a diffusible activation mediator that may be targeted via therapeutic intervention strategies. Furthermore, the degree of FDG uptake proved directly related to viral load and inversely related to CD4 cell count. Available data in acquired immune deficiency syndrome (AIDS)-defining cancers further suggest that FDG-PET/CT imaging may be useful for prognostication of cervical cancer and for identifying appropriate sites for biopsy, staging, and monitoring lymphoproliferative activity owing to HIV-associated Kaposi sarcoma and multicentric Castleman disease. Inversely, in HIV-associated lymphoma, FDG uptake in HIV-involved lymphoid tissue was shown to reduce the specificity of FDG-PET imaging findings, the effect ofwhich in clinical practicewarrants further investigation. In the latter setting, knowledge of viremia appears to be essential for FDG-PET image interpretation. Early HIV-associated neurocognitive disorder, formerly known as AIDS dementia complex, proved to be characterized by striatal hypermetabolism and progressive HIV-associated neurocognitive disorder or AIDS dementia complex by a decrease in subcortical and cortical metabolism. In lipodystrophicHIV-infected individuals, lipodystrophy proved associated with increased glucose uptake by adipose tissue, likely resulting fromthemetabolic stress of adipose tissue in response to highly active antiretroviral therapy. Furthermore, ongoing chronic low-grade infection in arteries of HIV-infected individuals could be depicted by FDG-PET/CT imaging. And there is promising data that FDG-PET/CT in HIVmay serve as a newmarker for the evaluation of thymic function in HIV-infected patients. In the setting of TB, FDG-PET has proven unable to differentiate malignancy from TB in patients presenting with solitary pulmonary nodules, including those suffering from HIV, and thus cannot be used as a tool to reduce futile biopsy or thoracotomy in these patients. In patients presenting with extrapulmonary TB, FDG-PET imagingwas found to be significantly more efficient when compared with CT for the identification of more sites of involvement. Thus supporting that FDG-PET/CT can demonstrate lesion extent, serve as guide for biopsywith aspiration for culture, assist surgery planning and contribute to follow-up. Limited available data suggest that quantitative FDG-PET findings may allow for prediction or rapid assessment, at 4 months following treatment instigation, of response to antituberculostatics in TB-infectedHIV patients. These results and more recent findings suggest a role for FDG-PET/CT imaging in the evaluation of therapeutic response in TB patients.en_US
dc.description.librarianhb2013en_US
dc.description.urihttp://www.ac.els-cdn.comen_US
dc.identifier.citationSathekge, M, Maes, A & Van de Wiele, C 2013, 'FDG-PET imaging in HIV infection and tuberculosis', Seminars in Nuclear Medicine, vol. 43, no. 5, pp. 349-366.en_US
dc.identifier.issn0001-2998 (print)
dc.identifier.issn1558-4623 (online)
dc.identifier.other10.1053/j.semnuclmed.2013.04.008
dc.identifier.urihttp://hdl.handle.net/2263/32123
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.rights© 2013 Elsevier. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in Seminars in Nuclear Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Seminars in Nuclear Medicine, vol. 43, no. 5, 2013, doi : 10.1053/j.semnuclmed.2013.04.008en_US
dc.subjectFDG-PET imagingen_US
dc.subjectHIV infectionen_US
dc.subjectTuberculosisen_US
dc.titleFDG-PET imaging in HIV infection and tuberculosisen_US
dc.typePostprint Articleen_US

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