Progressive Mostly Insidious progression (over weeks) of Diagnosis made PPx: Antiretroviral therapy Multifocal < 150 focal neurological deficits 2/2 patchy on clinical Leukoencephalopathy demyelinating process. presentation and Tx: There is no specific (PML) CT/MRI findings treatment for PML. The main strategy is restoring the host Symptoms may include: AMS, motor showing adaptive immune response (JC virus a human deficits, limb ataxia, gait ataxia, visual multifocal areas of – which can prolong survival papylomavirus symptoms, seizures. white matter – including starting/optimizing reactivates and infects demyelination ARVs oligodendrocytes and astrocytes) CSF + JC Virus Biopsy = Gold Standard Cryptococcal < 100 Symptoms of meningitis including The cryptococcal Ppx: Not generally indicated Mengingitis headache, nausea/vomiting, fatigue, antigen may be confusion, sensitivity to fever, detected in CSF or Tx: Amphotericin B plus (Caused by the fungus stiff neck blood. flucytosine followed by Cryptococcus prolonged course of neoformans) LP is diagnostic - fluconazole elevated opening pressure, positive CSF crypt ag, CSF fungal culture Kaposi Sarcoma < 200 Purple colored skin lesions (may occur Biopsy ART (Vascular tumor on the mucosal surfaces where they + Local or systemic therapy associated with human can’t be visualized from the outside) depending on the extent of herpesvirus 8) the disease
Progressive Multifocal Leukoencephalopathy (PML) (JC virus – a human papylomavirus – reactivates and infects oligodendrocytes and astrocytes) Mostly < 150 Insidious progression (over weeks) of focal neurological deficits 2/2 patchy demyelinating process. Symptoms may include: AMS, motor deficits, limb ataxia, gait ataxia, visual symptoms, seizures. Diagnosis made on clinical presentation and CT/MRI findings showing multifocal areas of white matter demyelination CSF + JC Virus Biopsy = Gold Standard PPx: Antiretroviral therapy Tx: There is no specific treatment for PML. The main strategy is restoring the host adaptive immune response which can prolong survival including starting/optimizing ARVs Cryptococcal Mengingitis (Caused by the fungus Cryptococcus neoformans) < 100 Symptoms of meningitis including headache, nausea/vomiting, fatigue, confusion, sensitivity to fever, stiff neck The cryptococcal antigen may be detected in CSF or blood. LP is diagnostic - elevated opening pressure, positive CSF crypt ag, CSF fungal culture Ppx: Not generally indicated Tx: Amphotericin B plus flucytosine followed by prolonged course of fluconazole Kaposi Sarcoma (Vascular tumor associated with human herpesvirus 8) < 200 Purple colored skin lesions (may occur on the mucosal surfaces where they can’t be visualized from the outside) Biopsy ART + Local or systemic therapy depending on the extent of the disease
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