Primary vasculitis of the central nervous system in patients infected with HIV-1 in the HAART era

J Med Virol. 2009 Apr;81(4):578-81. doi: 10.1002/jmv.21462.


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.

Publication types

  • Case Reports

MeSH terms

  • AIDS Arteritis, Central Nervous System* / diagnostic imaging
  • AIDS Arteritis, Central Nervous System* / drug therapy
  • AIDS Arteritis, Central Nervous System* / immunology
  • AIDS Arteritis, Central Nervous System* / virology
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • Central Nervous System Diseases / complications*
  • Central Nervous System Diseases / diagnostic imaging
  • Central Nervous System Diseases / drug therapy
  • Central Nervous System Diseases / immunology
  • Cerebrum / blood supply
  • Cerebrum / diagnostic imaging
  • Cerebrum / virology
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / immunology
  • HIV Infections / pathology
  • HIV Infections / virology
  • HIV-1 / drug effects
  • HIV-1 / pathogenicity
  • Humans
  • Immunosuppression Therapy
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Radiography
  • Stroke / complications*


  • Adrenal Cortex Hormones