An HIV-positive patient may develop a severe, demyelinating leukoencephalopathy after being started on antiretroviral therapy. The condition may be a consequence of immune restoration associated with the therapy.


Clinical features:

(1) The patient has advanced HIV disease and is being treated with HAART (highly active antiretroviral therapy).

(2) Most patients have poorly controlled HIV replication with AIDS defining conditions.

(3) Many patients have HIV-associated dementia.

(4) T2-weighted MRI scan show hyperintensities in white matter, either multifocal or diffuse.

(5) Exclusion of other causes of leukoencephalopathy.


Neuropathologic findings include:

(1) widespread myelin loss and axonal injury.

(2) intense perivascular infiltrate of lymphocytes and monocytes

(3) high levels of HIV RNA


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