We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Human Immunodeficiency Virus Encephalopathy Cognitive and Radiologic Improvement After Antiretroviral Therapy

Marcus Tulius T. Silva, MD, PhD; Sandra Wagner, MD, PhD; Beatriz Grinsztejn, MD, PhD
Arch Neurol. 2009;66(8):1040-1041. doi:10.1001/archneurol.2009.156.
Text Size: A A A
Published online


In October 2007, a 41-year-old human immunodeficiency virus (HIV)–positive Brazilian woman was admitted to the hospital because of mild gait disturbance and difficulty in memory and concentration. She had a recent history of weakness, oral candidiasis, and weight loss. Neurologic examination revealed brisk tendon reflexes in the upper and lower limbs, sluggishness of ocular persecutory movements, unsteady gait, and slowness of alternated fast movements. A brief neuropsychological assessment of the patient revealed psychomotor slowness and diminished verbal fluency (Table). Her CD4 cell count and HIV viral load were 71/μL and 851.569 copies/mL (5.9 log), respectively. Brain magnetic resonance imaging (MRI) revealed diffuse white matter abnormalities without gadolinium enhancement (Figure, A). Cerebrospinal fluid analysis revealed 2 cells/μm3 (100% mononuclear), a glucose level of 46 mg/dL (to convert glucose to millimoles per liter, multiply by 0.0555), and a protein level of 0.7 g/dL (to convert protein to grams per liter, multiply by 10.0); the results of JC virus DNA polymerase chain reaction were negative. Two transcriptase nonnucleoside inhibitors and 1 protease inhibitor were prescribed. The patient was followed up monthly, and clinical improvement was apparent soon after antiretroviral therapy. A new neuropsychological assessment performed 6 months later showed marked improvement in all tests. At this time, the CD4 cell count was 139/μL and the HIV viral load was undetectable. Brain MRI performed in the seventh month of therapy showed marked improvement of white matter abnormalities seen in the baseline assessment (Figure, B). During this time, the patient returned to all of her daily activities.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

Fluid-attenuated inversion recovery (FLAIR) images. A, FLAIR (repetition time, 9500 milliseconds; echo time, 100 milliseconds; time of inclination, 2500 milliseconds) axial image before antiretroviral treatment shows diffuse, nonenhanced white matter lesions. B, A subsequent magnetic resonance image (FLAIR; repetition time, 9500 milliseconds; echo time, 100 milliseconds; time of inclination, 2500 milliseconds) performed after 7 months of highly active antiretroviral therapy shows notable improvement of magnetic resonance signal abnormalities.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles