PT  - JOURNAL ARTICLE
AU  - Majda M. Thurnher
AU  - M. Judith Donovan Post
AU  - Armin Rieger
AU  - Christina Kleibl-Popov
AU  - Christian Loewe
AU  - Erwin Schindler
TI  - Initial and Follow-up MR Imaging Findings in AIDS-Related Progressive Multifocal Leukoencephalopathy Treated with Highly Active Antiretroviral Therapy
DP  - 2001 May 01
TA  - American Journal of Neuroradiology
PG  - 977--984
VI  - 22
IP  - 5
4099  - http://www.ajnr.org/content/22/5/977.short
4100  - http://www.ajnr.org/content/22/5/977.full
SO  - Am. J. Neuroradiol.2001 May 01; 22
AB  - BACKGROUND AND PURPOSE: Recent studies have shown the beneficial effect of highly active antiretroviral therapy (HAART) in AIDS-related progressive multifocal leukoencephalopathy (PML). The purpose of our study was to evaluate the initial and follow-up imaging findings and survival in patients with PML who were treated with HAART.METHODS: The clinical course and MR imaging findings on initial and follow-up MR studies in four consecutive AIDS patients with PML who were treated with HAART are described.RESULTS: Two patients were short-term survivors and died after 3 months. Two patients are still alive, with a survival time of 22 and 43 months, respectively. On initial MR studies, more extensive white matter changes were seen in the short-term survivors. Development of a mass effect and temporary enhancement (in one patient) was observed in two HAART responders on follow-up MR studies. Increased hypointensity on T1-weighted images with concomitant low signal on fluid-attenuated inversion-recovery fast spin-echo (FLAIR-FSE) images was seen in two responders, representing leukomalacia. Atrophic changes of the involved areas of the brain, consistent with burnt out PML lesions, were seen in two long-term survivors. In the short-term survivors, increased hypointensity was present on T1-weighted images with increased high signal on FLAIR-FSE images, representing progressive destructive disease.CONCLUSION: Our results suggest that a clinical and radiologic response can be seen in some patients with AIDS-associated PML on HAART while in others there may be no beneficial response. Development of a mass effect and temporary enhancement on MR images in the early phase of treatment might represent positive predictive factors for prolonged survival.