PET/CT scanning with a high HIV/AIDS prevalence

Positron emission tomography (PET) with [F-18]-fluoro-deoxy-glucose (FDG) has a well established and growing role in the management of most lymphomas. The interpretation of FDG PET scans in HIV positive patients is however challenging. This is largely due to scan changes giving a higher likelihood of false positive studies from both the direct effects of HIV and its treatment, and related to secondary HIV-related pathology. There is currently a need for further clinical research to evaluate to contribution of FDG PET in the management of HIV positive patients with lymphoma. In this paper existing studies related to FDG PET scanning in HIV positive patients will be reviewed, and potential pitfalls will be identified. These pitfalls can be avoided to some extent by the interpreter having a good clinical knowledge of the individual patients’ condition, and an awareness of known scintigraphic patterns that can occur in these patients. PET remains a sensitive tool for the localisation of pathology, however when the exact nature of lesions has a direct bearing on patient management lesions need to be biopsied where possible. FDG PET can be particularly useful for the characterisation of brain lesions suspected to be related to primary central nervous system lymphoma.