HIV encephalitis

Findings

Mild parenchymal volume loss with symmetric nonenhancing periventricular and subcortical white matter T2 prolongation. No mass effect.

Differential diagnosis:
- Microvascular disease
- HIV encephalitis
- PML
- Toxo/lymphoma
- Chemotherapy/Radiation
- Leukodystrophy
- Demyelination – MS, ADEM


Diagnosis: HIV encephalitis (known HIV infection).


Key Points: HIV Encephalitis / AIDS Dementia complex

Cognitive disturbances that progress to dementia
7-27% of AIDS patients
Direct CNS infection by HIV +/- CMV
MR imaging primarily shows central volume loss and diffuse or periventricular white matter disease (both demyelination and gliosis)
Can be difficult to differentiate from PML
Pre-HAART (Highly Active Antiretroviral Therapy) prognosis was poor, but HAART therapy is felt to decrease incidence and induce remission.