Disappearance of an Intracerebral Arteriovenous Malformation in an HIV-Infected Patient after Initiation of HAART

Abstract

HIV infection or complications of HIV-induced immunodeficiency may affect the central nervous system (CNS). However, vascular cerebral pathologies are very rare, in particular intracerebral arteriovenous malformations (AVM). We report the case of an HIV-infected patient who had a cerebral AVM leading to symptoms such as recurring focal seizures. Only after initiation of potent antiretroviral combination therapy, but not antiretroviral monotherapy or bitherapy, could the viral load be suppressed and immunodeficiency resolved. Two years after the start of highly active antiretroviraL therapy (HAART) total occlusion of the AVM could be demonstrated. Taken together, this case report may demonstrate the potent angiogenic activity of HIV for AVM. Also, this case report might show that inhibition of such a cofactor may lead to resolution of an AVM.

Multiple Symptomatic Cerebral Arteriovenous Malformations in a Patient with HIV

“…7,8 HIV-associated cerebral vasculopathy was proposed as an important mechanism of stroke in the absence of a known cause, possibly related to deposition of a circulating immune complex or a direct toxic effect on the vascular endothelium. 9 Kure et al We only found 1 case report by Wolf et al 12 describing a 53-year-old patient with HIV infection who had a right Rolandic cerebral AVM leading to recurring focal seizures. There was a single draining vein with a large varix and a flow-related arterial aneurysm.…”

Surgical Treatment of Arteriovenous Malformation in a Patient With Human Immunodeficiency Virus Infection and Hemophilia A: Case Report

“…The AVM disappeared after treatment with highly active antiretroviral therapy. 9 Significant viral angiogenic potential has been demonstrated in HIV-positive patients coinfected with human herpesvirus 8. 10 Indeed, Wolf et al 9 has suggested that viruses are significant cofactors for angiogenic processes and activation of AVM.…”

“…9 Significant viral angiogenic potential has been demonstrated in HIV-positive patients coinfected with human herpesvirus 8. 10 Indeed, Wolf et al 9 has suggested that viruses are significant cofactors for angiogenic processes and activation of AVM. Consequently, HIV infection might be a risk factor for the development of AVM and ICH in patients with hemophilia.…”

Reply to: K.Wolf et al.

“…Wolf et al [1] recently reported the disappearance of an intracerebral arteriovenous malformation in an HIVl-infected patient after highly active retroviral therapy (HAART) initiation.Their explanation for this unusual observation was that HIV1-dependent angiogenesis was shut down by the antiviral effect of HAART. We would like to suggest another hypothesis.…”

“…We would like to suggest another hypothesis. Indeed, the patient described by Wolf et al [1] took indinavir . Indeed, the patient described by Wolf et al [1] took indinavir .…”