Neuropsychological and neuroimaging outcome of HIV-associated progressive multifocal leukoencephalopathy in the era of antiretroviral therapy.

AIMS: The purpose of the present case is to describe the functional outcome of a patient with human immunodeficiency virus (HIV) and progressive multifocal leukoencephalopathy (PML) on treatment with antiretroviral therapy using a multidisciplinary approach.

METHODS

Neuropsychological tests and diffusion tensor imaging (DTI) were obtained at baseline and after 12 months to define the severity of white matter damage. Neuropsychological and neuroimaging data were compared to an HIV-infected patient without PML and with good immune system health, and to a second HIV-infected patient without PML but with notable immunosuppression.

RESULTS

Review of the HIV/PML patient's cognitive data at both time points revealed significant impairments compared to the control subjects. Similarly, the HIV/PML patient's white matter lesion load and whole brain volume were markedly different from the control subjects at both time points. The tractography-defined metrics suggest significant white matter fiber loss associated with HIV/PML that was not evident in either HIV control patient.

DISCUSSION: Our findings suggest that PML is associated with marked cognitive and neuroimaging abnormalities in the context of antiretroviral therapy.

INTEGRATIVE SIGNIFICANCE: To our knowledge this is the first study to integrate both quantitative DTI and cognitive assessment to define white matter damage associated with HIV and PML. This integrative approach provides a robust methodology to examine the integrity of brain systems mediating cognitive function.