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Primary vasculitis of the central nervous system in patients infected with HIV‐1 in the HAART era
Author(s) -
Melica Giovanna,
Brugieres Pierre,
Lascaux AnneSophie,
Levy Yves,
Lelièvre JeanDaniel
Publication year - 2009
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.21462
Subject(s) - immunosuppression , medicine , vasculitis , concomitant , immunology , central nervous system , viral load , immunopathology , lymphoproliferative disorders , cerebral vasculitis , disease , human immunodeficiency virus (hiv) , pathology , lymphoma
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. J. Med. Virol. 81:578–581, 2009 © 2009 Wiley‐Liss, Inc.