Primary vasculitis of the central nervous system in patients infected with HIV-1 in the HAART era.
Angiitis of the central nervous system (CNS) in patients infected with HIV-1-is often associated with concomitant infection or lymphoproliferative disease of the CNS. Four HAART naïve patients infected with HIV-1 with severe stroke are described. Evidence of vasculitis was found by magnetic resonance angiography. Extensive investigations excluded concomitant opportunistic, lymphoproliferative or autoimmune disorders leading to the diagnosis of primary angiitis of the CNS. Despite initiation of HAART and prolonged suppression of viral replication, these patients remained severely immunosuppressed. The addition of corticosteroids led to a significant improvement of clinical symptoms. Primary angiitis of the CNS should be considered in patients with HIV and stroke. The prognosis of these patients remain poor despite HAART. These observations suggest that the vascular inflammatory process persists despite the control of viral load under HAART in patients with persistent immunosuppression.
Melica
Giovanna
G
Service d'Immunologie Clinique, CHU Henri Mondor, Créteil, France.
Brugieres
Pierre
P
Lascaux
Anne-Sophie
AS
Levy
Yves
Y
Lelièvre
Jean-Daniel
JD
D020943:AIDS Arteritis, Central Nervous System / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002493:Central Nervous System Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000276:immunology; D054022:Cerebrum / Q000098:blood supply / Q000000981:diagnostic imaging / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D007165:Immunosuppression Therapy; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020521:Stroke / Q000150:complications*
D000305:Adrenal Cortex Hormones