Highly active antiretroviral therapy for patients with AIDS dementia complex: Effect on MR imaging findings and clinical course

BACKGROUND AND PURPOSE: Recent studies have reported the clinical improveme nt in patients with AIDS treated with a combination of antiretroviral regim ens. The purpose of our study was to describe the effects of highly active antiretroviral therapy on MR images in patients with HIV encephalopathy and to compare the clinical course with follow-up neuroimaging studies. METHODS: Initial and follow-up MR imaging findings are described in four pa tients with AIDS dementia complex at baseline and after antiretroviral ther apy, and correlated with clinical and immunologic findings. RESULTS: Initial MR imaging revealed white matter signal abnormalities on l ong-TR images without mass effect and without enhancement on postcontrast i mages, consistent with HIV encephalopathy, Lesions were located in the basa l ganglia and posterior fossa in two patients. All four patients showed pro gression of white matter disease on the first follow-up MR scan (mean, 6 mo nths). On subsequent scans, regression was seen in three patients and stabi lization of white matter disease was observed in one patient. Increases in CD4+ count and decreases in viral load below the limit of quantification we re present in all patients. CONCLUSION: Although our patient population was small, the results suggest that disease regression in patients with AIDS dementia complex after treatm ent with highly active antiretroviral therapy can be characterized and moni tored by MR imaging.