title: Progressive multifocal leukoencephalopathy in an HIV patient receiving successful long-term HAART.
abstract: Progressive multifocal leukoencephalopathy (PML) has been traditionally associated to severe immunosuppression and described mainly in highly active antiretroviral therapy (HAART)-naïve patients with a low lymphocyte CD4+ count. In the last years, some cases of PML have been described in HIV patients with a higher CD4+ count shortly after initiation of HAART and in association with the immune reconstitution inflammatory syndrome (IRIS). We report on a rare case of PML, not IRIS associated, that occurred in a HIV-positive patient with a lymphocyte CD4+ count greater than 700/µl and with an undetectable HIV viral load resulting from a long-term HAART. We describe the pathological and the ultrastructural features of the brain lesion. This case confirms that a severe immunosuppression or an IRIS is not required for the development of PML in HIV positives. The diagnosis of PML should always be considered in patients with consistent neurological symptoms, even with a high lymphocyte CD4+ level and a full viral suppression resulting from a long-term HAART.
authors: Department of Infectious Diseases, University of Verona, Verona, Italy. martamasca@yahoo.it
authors: Marta
authors: M
authors: Mascarello
authors: Massimiliano
authors: M
authors: Lanzafame
authors: Emanuela
authors: E
authors: Lattuada
authors: Ercole
authors: E
authors: Concia
authors: Sergio
authors: S
authors: Ferrari
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001921:Brain / Q000473:pathology* / Q000648:ultrastructure / Q000821:virology*; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006678:HIV / Q000187:drug effects / Q000254:growth & development; D006801:Humans; D007165:Immunosuppression Therapy; D007558:Italy; D007577:JC Virus / Q000472:pathogenicity; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy / Q000209:etiology / Q000473:pathology* / Q000821:virology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral