Multiple sclerosis remission following antiretroviral therapy in an HIV-infected man.

Abstract

Multiple sclerosis (MS) can be a challenging diagnosis under the best of circumstances and this is especially true when demyelinating disease occurs in association with human immunodeficiency virus (HIV). Among the large spectrum of neurological disease associated with HIV are disorders that frequently affect the white matter, most commonly, HIV dementia and progressive multifocal leukoencephalopathy. Among the demyelinating disorders observed with HIV infection are acute disseminated encephalomyelitis (ADEM), MS or a MS-like illness, and neuromyelitis optica (NMO). On occasion, the demyelinating disorder is monophasic and is likely an isolated autoimmune event triggered by the viral infection. This clinical expression mimics ADEM and often, but not invariably, occurs proximate to the time of HIV seroconversion (Bhigjee, Patel et al. 1999; Narciso, Galgani et al. 2001; van Toorn, Kritzinger et al. 2005; Raychaudhuri, de Silva et al. 2006; Tullu, Patil et al. 2011). An aggressive course of MS has been described as well with autopsy confirmation of demyelinating plaques indistinguishable from those of MS (Berger, Sheremata et al. 1989; Gray, Chimelli et al. 1991). In other instances, the course of the MS-like illness is more reflective of that typical of relapsing remitting MS in a non-HIV-infected person (Berger, Sheremata et al. 1989; Gonzalez-Duarte, Ramirez et al. 2011). NMO or a related disorder has also been reported in association with HIV infection (Berger, Tornatore et al. 1992; Blanche, Diaz et al. 2000; Feyissa, Singh et al. 2013). We report a man who presented with an MS-like illness conforming to McDonald criteria for MS whose demyelinating disease, both clinically and radiographically, abated following the institution of effective antiretroviral therapy. This observation has been described in at least one other HIV-infected patient with an MS-like illness (Maruszak, Brew et al. 2011) and another with a mixed MSNMO pattern of disease (Delgado, Maldonado et al. 2014).