Journal of Multiple Sclerosis

Neurological Deterioration in a PML-HIV Patient in the Absence of Immune Reconstitution Inflammatory Syndrome

Valerie Arias M, Sarah E. Martin, John Farrell and Jorge C Kattah4

Following the initiation of HIV treatment AIDS patients with progressive multifocal leukoencephalopathy (PML) may clinically worsen because of either: 1) Immune Reconstitution Inflammatory Syndrome (IRIS) which is supported by marked deterioration of their MRI findings or 2) progressive JC virus (JCV) CNS infection, often characterized by stable or minimally changed MRI findings. We present a 35-year-old PML-HIV patient with neurological deterioration and death despite early and successful highly active antiretroviral therapy (HAART), in the absence of IRIS. We hypothesize that HIV induced irreversible depletion of T-cells leading to an inability to mount an effective response to the JCV infection.