Multiple sclerosis-like illness in early HIV infection

Gräber, Peter; Rosenmund, A; Probst, A.; Zimmerli, Werner

doi:10.1097/00002030-200010200-00029

Cited by 24 publications

(36 citation statements)

References 6 publications

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“…In most reported cases, MS-like disease was associated with early HIV infection and, in fact, a significant number of cases occurred in temporal association with HIV seroconversion [2, 3]. ADEM has also been reported as manifestation of primary HIV infection [11].…”

Section: Discussionmentioning

confidence: 99%

“…ADEM has also been reported as manifestation of primary HIV infection [11]. Although the pathogenesis of these demyelinating CNS disorders remains unknown, an autoimmune disorder in association with HIV infection has been suggested [1, 2, 3, 6, 10, 14]. HIV infection of the CNS might induce a demyelinating disease of variable severity that could present as an acute diffuse leukoencephalopathy, ADEM, remitting-relapsing MS-like leukoencephalopathy, or focal monophasic leukoencephalopathy [6].…”

Section: Discussionmentioning

confidence: 99%

“…A multiple sclerosis (MS)-like disease, with either a relapsing-remitting [1, 2, 3, 4, 5]or fulminating fatal course [6], has occasionally been reported in association with human immunodeficiency virus (HIV) infection. In most cases, this MS-like disease was the presenting symptom of HIV infection and occurred in patients with a relatively preserved immune function.…”

Section: Introductionmentioning

confidence: 99%

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Focal Monophasic Demyelinating Leukoencephalopathy in Advanced HIV Infection

Corral¹,

Quereda²,

García-Villanueva

et al. 2004

Eur Neurol

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A multiple sclerosis (MS)-like illness has been reported in human immunodeficiency virus (HIV)-infected patients, usually in the early stages of HIV infection. We report 3 patients with advanced HIV infection (CD4 lymphocyte count under 200/mm³) presenting with monophasic focal leukoencephalopathy, in whom biopsy demonstrated demyelinating lesions compatible with acute MS lesions. In 1 patient, recently started on highly active antiretroviral therapy, MS-like disease could represent an immune reconstitution syndrome. The lesions were reversible in 2 patients, but rapidly fatal in the third patient. These cases show that an MS-like disease may present in advanced HIV infection as focal monophasic leukoencephalopathy with either a reversible or fulminating course, mimicking progressive multifocal leukoencephalopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Focal Monophasic Demyelinating Leukoencephalopathy in Advanced HIV Infection

Corral¹,

Quereda²,

García-Villanueva

et al. 2004

Eur Neurol

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“…Ainsi, diverses présentations de patients avec des symptômes de leucoencépha-lopathie aiguë difficile à différentier de la SEP ont été faites. Ces symptômes apparaissaient soit concomitamment à la séro-conversion VIH, soit endéans les trois mois [1][2][3][4][5]8,9]. Dans la majorité des cas, il existait une étroite relation temporelle entre le développement des symptômes neurologiques et la détermi-nation de la séropositivité pour le VIH, indiquant, comme chez notre patient, un temps de latence très court entre l'acquisition du virus et la survenue des symptômes.…”

Section: Discussionunclassified

“…Son étiologie reste à ce jour inconnue ; on note toutefois la conjonction des facteurs génétiques, environnementaux, immuns et infectieux dans la genèse de la maladie. Récemment, il a été rapporté l'existence intrigante de lésions démyélinisantes mimant la SEP chez des patients à diffé-rents stades de l'infection VIH [1][2][3][4][5]. Bien qu'aucune particule virale n'ait été détectée, le rôle du VIH est suspecté.…”

Section: Introductionunclassified

Lésions cérébrales démyélinisantes découvertes chez un patient immunocompétent VIH-1+

Nkoghe

Moutschen

Demonty

2008

Médecine et Maladies Infectieuses

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RésuméDes lésions cérébrales démyélinisantes similaires à la sclérose en plaques ont été découvertes chez un patient de 32 ans VIH immunocompétent. À l'histologie, une inflammation avec nécrose, démyélinisation et destruction des axones a été notée. Divers tests sérologiques, des cultures spécifiques et la PCR pour plusieurs agents infectieux étaient négatifs. La corticothérapie et les antibiotiques se sont révélés sans effet. Une trithérapie antirétrovirale et l'ablation d'une des lésions ont permis la résorption complète des nodules, sans récurrence. Cette atteinte démyélinisante semblait être la première manifestation d'une primo-infection. L'implication du VIH dans la genèse du processus et sa pérennisation a été suspectée mais le mécanisme responsable n'est pas clair, probablement auto-immun. L'inhibition de la réplication virale induite par le traitement combiné réduirait les effets dysimmunitaires du VIH. Notre présentation constitue la première description de l'efficacité indirecte d'une trithérapie sur des lésions cérébrales démyélinisantes chez un patient immunocompétent. © 2008 Elsevier Masson SAS. Tous droits réservés. AbstractWe report the case of a 32-year-old immunocompetent HIV patient, presenting with acute demyelinating leukoencephalopathy. The patient displayed clinical and radiological features similar to multiple sclerosis. Histology revealed inflammation with necrosis, demyelination and destruction of axons. Serum tests were negative for various infectious agents as well as specific cultures and PCR. Corticotherapy and many antibiotic treatments failed. Resorption of the lesions occurred after partial excision and highly-active antiretroviral therapy (HAART). No recurrence was noted. This demyelinating cerebral disease was considered as the primary manifestation of HIV infection. HIV implication in the genesis of the process and its perpetuating this condition was suspected, but the mechanism is unclear. Dysimmune consequences related to the early course of HIV infection could be prevented by antiretroviral treatment. This study was the first description of tritherapy effectiveness on HIV related multiple sclerosis (MS)-like illness.

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Risk of Multiple Sclerosis in People Living with HIV: An International Cohort Study

McKay,

Wijnands,

Manouchehrinia

et al. 2023

Annals of Neurology

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ObjectiveThere has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population.MethodsPopulation‐based health data were accessed for 2 cohorts of HIV‐positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1 year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada = April 1, 1992 and Sweden = January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada = March 31, 2020 and Sweden = December 31, 2018). The observed MS incidence rate in the HIV‐positive cohort was compared to the expected age‐, sex‐, calendar year‐, income‐specific, and region of birth‐specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure (“ART‐exposed”) was also calculated.ResultsThe combined Sweden‐Canada cohort included 29,163 (75% men) HIV‐positive persons. During 242,248 person‐years of follow‐up, 14 incident MS cases were observed in the HIV‐positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV‐positive population was 0.53 (95% confidence interval [CI] = 0.32–0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI = 0.31–0.96).InterpretationThis international population‐based study demonstrated a lower risk of MS among HIV‐positive individuals, and HIV‐positive ART‐exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2023

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Multiple sclerosis-like illness in early HIV infection

Cited by 24 publications

References 6 publications

Focal Monophasic Demyelinating Leukoencephalopathy in Advanced HIV Infection

Focal Monophasic Demyelinating Leukoencephalopathy in Advanced HIV Infection

Lésions cérébrales démyélinisantes découvertes chez un patient immunocompétent VIH-1+

Risk of Multiple Sclerosis in People Living with HIV: An International Cohort Study

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