Inflammatory progressive multifocal leukoencephalopathy in human immunodeficiency virus-negative patients

Ann Neurol. 2007 Jul;62(1):34-9. doi: 10.1002/ana.21085.


Objective: Inflammatory progressive multifocal leukoencephalopathy (iPML) with enhancing magnetic resonance imaging (MRI) lesions and leukocyte infiltration occurs in human immunodeficiency virus (HIV)-infected individuals after highly active antiretroviral therapy (HAART) treatment. MRI diagnostic criteria for PML suggest that iPML does not occur in HIV-negative individuals.

Methods: We studied pathologically proved PML (12 by biopsy, 9 with MRI, 32 at autopsy).

Results: HIV-negative (2/5) and -positive (2/4) PML patients had enhancing MRI lesions, correlated with CD3(+) lymphocyte infiltration. Inflammatory infiltrates occurred in the majority of HIV-negative (7/8) and HIV-positive/HAART (17/20) cases (p > 0.2), but in only 2 of 16 HIV-positive/non-HAART cases (p < 0.001).

Interpretation: iPML showed radiographic and pathological similarity in HIV-positive/HAART and HIV-negative patients. HIV-negative iPML necessitates further consideration of MRI criteria for PML.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiretroviral Therapy, Highly Active
  • Biopsy
  • Brain / pathology
  • Brain / virology
  • CD4 Lymphocyte Count
  • Chi-Square Distribution
  • Female
  • HIV
  • HIV Infections / drug therapy
  • HIV Infections / pathology*
  • Humans
  • Leukoencephalopathy, Progressive Multifocal / etiology*
  • Leukoencephalopathy, Progressive Multifocal / immunology
  • Leukoencephalopathy, Progressive Multifocal / pathology*
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged