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Imaging of the Brain in Patients With Human Immunodeficiency Virus Infection

Gottumukkala, Ravi V. BA*; Romero, Javier M. MD; Riascos, Roy F. MD; Rojas, Rafael MD§; Glikstein, Rafael S. MD

Topics in Magnetic Resonance Imaging: October 2014 - Volume 23 - Issue 5 - p 275–291
doi: 10.1097/RMR.0000000000000031
Review Articles

Neurologic disease in acquired immunodeficiency syndrome (AIDS) patients is related either to opportunistic pathogens or to direct central nervous system (CNS) invasion by the human immunodeficiency virus. Despite the increasing availability of antiretroviral therapy, opportunistic infections continue to afflict patients in the developing world and in other populations with limited access to appropriate treatment. Classic CNS infections in the setting of AIDS include toxoplasmosis, cryptococcosis, progressive multifocal leukoencephalopathy, and cytomegalovirus encephalitis. Additionally, AIDS patients are far more susceptible to acquiring CNS tuberculosis and neurosyphilis, both of which exhibit altered disease characteristics in the setting of immunosuppression. Neuroimaging is a crucial component of the diagnostic work-up of these conditions, and findings include, but are not limited to, intracranial mass lesions, white matter disease, meningoencephalitis, vascular complications, and hydrocephalus. Though various disease processes can produce imaging findings that overlap with one another, certain characteristic patterns may suggest a particular pathogen, and advanced imaging techniques and laboratory tests allow for definitive diagnosis. Knowledge of the imaging patterns seen in the setting of AIDS-related CNS disease is vital to the neuroradiologist, whose interpretation may guide decisions related to treatment and further work-up.

From the *Washington University School of Medicine, St. Louis, MO; †Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; ‡Department of Radiology, University of Texas Medical Branch, Galveston, TX; §Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and ∥Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON.

Reprints: Ravi V. Gottumukkala, BA, 6813 Fieldstone Drive, Burr Ridge, IL 60527 (e-mail:

The authors declare no conflict of interest.

© 2014 Lippincott Williams & Wilkins, Inc.