Abstract
Multiple sclerosis (MS) has been infrequently described in association with human immunodeficiency virus (HIV) infection. Underreporting, missed diagnoses or a true negative association between MS and HIV infection are all possible explanations for the paucity of published cases. Since MS involves inflammation and demyelination of the central nervous system by autoreactive T cells, immunosuppression caused by HIV infection would be expected to confer a reduced risk of MS. This report describes a case of relapsing-remitting MS in a woman with non-progressive HIV-1 infection for 5 years. The patient has stable normal CD4+ cell counts and a low viral load in the absence of combination antitretroviral treatment (cART). She experienced typical neurological symptoms of MS including optic neuritis, trigeminal neuralgia, and transverse myelitis. MRI of the spinal cord demonstrated multiple lesions on T2-weighted images. Immune mechanisms associated with HIV control that may have contributed to the development and relapses of MS in this patient are discussed.
This is a preview of subscription content, log in via an institution to check access.
References
Berger JR, Sheremata WA, Resnick L, Atherton S, Fletcher MA, Norenberg M (1989) Multiple sclerosis-like illness occurring with human immunodeficiency virus infection. Neurology 39:324–329
Chakrabarti L, Simon V (2010) Immune mechanisms of HIV control. Curr Opin Immunol 22:488–496
Chalkley J, Berger JR (2014) Multiple sclerosis remission following antiretroviral therapy in an HIV-infected man. J Neurovirol 20:640–643
Delgado SR, Maldonado J, Rammohan KW (2014) CNS demyelinating disorder with mixed features of neuromyelitis optica and multiple sclerosis in HIV-1 infection. Case report and literature review. J Neurovirol 20:531–537
Feyissa AM, Singh P, Smith RG (2013) Neuromyelitis optica in patients with coexisting human immunodeficiency virus infections. Mult Scler 19:1363–1366
Fletcher JM, Lalor SJ, Sweeney CM, Tubridy N, Mills KHG (2010) T cells in multiple sclerosis and experimental autoimmune encephalomyelitis. Clin Exp Immunol 162:1–11
Gaardbo JC, Hartling HJ, Gerstoft J, Nielsen SD (2012) Thirty years with HIV infection—nonprogression is still puzzling: lessons to be learned from controllers and long-term nonprogressors. AIDS Res Treat. doi:10.1155/2012/161584
Gold J, Goldacre R, Maruszak H, Giovannoni G, Yeates D, Goldacre M (2015) HIV and lower risk of multiple sclerosis: beginning to unravel a mystery using a record-linked database study. J Neurol Neurosurg Psychiatry 86:9–12
González-Duarte A, Ramirez C, Pinales R, Sierra-Madero J (2011) Multiple sclerosis typical clinical and MRI findings in a patient with HIV infection. J Neurovirol 17:504–508
Maruszak H, Brew BJ, Giovannoni G, Gold J (2011) Could antiretroviral drugs be effective in multiple sclerosis? A case report. Eur J Neurol 18:e110–e111
Multiple Sclerosis International Federation (2013) Atlas of MS 2013. Available via http://www.msif.org/about-us/advocacy/atlas-test/atlas-of-ms/. Accessed 12 February 2015
Nissen KK, Laska MJ, Hansen B, Terkelsen T, Villesen P, Bahrami S, Petersen T, Pedersen FS, Nexø BA (2013) Endogenous retroviruses and multiple sclerosis—new pieces to the puzzle. BMC Neurol 13:111. doi:10.1186/1471-2377-13-111
Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
Poropatich K, Sullivan DR (2011) Human immunodeficiency virus type 1 long-term non-progressors: the viral, genetic and immunological basis for disease non-progression. J Gen Virol 92:247–268
Sato DK, Callegaro D, Lana-Peixoto MA, Waters PJ, de Haidar Jorge FM, Takahashi T, Nakashima I, Apostolos-Pereira SL, Talim N, Simm RF, Lino AMM, Misu T, Leite MI, Aoki M, Fujihara K (2014) Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. Neurology 82:474–481
Acknowledgments
The author thanks Dr. Abdu Musubire (Infectious Disease Institute, Makerere University, Kampala, Uganda) for his assistance obtaining diagnostic studies for this patient.
Conflict of interest
The author declares that he has no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chin, J.H. Multiple sclerosis and HIV-1 infection: case report of a HIV controller. J. Neurovirol. 21, 464–467 (2015). https://doi.org/10.1007/s13365-015-0335-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13365-015-0335-1