HIV Neurology Center
Most Sophisticated Treatments Available
for HIV-Related Neurological Conditions
The HIV/Neurology Center offers comprehensive care for acute and chronic neurological problems in people with HIV infection or AIDS. Neurological disturbances occur in 30-50% of HIV-infected persons and can present as the initial symptom, throughout the course of the disease or in advanced AIDS.
As a patient of our center, you will have access to the most sophisticated treatments available, and be able to participate in current clinical treatment trials. In addition, we will assist you in getting more information about your condition with the help of the Beth Israel Deaconess Learning Center.
Progressive Multifocal Leukoencephalopathy (PML) is an infectious disease of the brain. It is caused by reactivation of a common virus that infects and destroys white matter of the brain. Neurological symptoms caused by this disease vary, as they depend on the location where the virus-caused destruction (lesion).
This virus, human polyomavirus JC (JCV), is found in up to 86% of the adult population. Typically, JCV is acquired during childhood, probably through a urine-oral route, after which it remains present but inactive in the body, residing in the kidneys, tonsils, bone marrow and possibly brain.
Most people infected with JC virus never have a problem. However, in a small percentage of the JCV-positive population, usually in immunocompromised individuals, JC virus gets reactivated and causes PML. Before the AIDS epidemic, PML was a rarity, mostly seen in transplant recipients or patients with hematological malignancies. About 5% of untreated patients with AIDS develop PML, and PML is still a major cause of death among AIDS patients even treated with combined antiretroviral therapy (cART).
Classic PML is characterized by the destruction of white matter of the brain. White matter is partly composed of nerve cell projections, wrapped in a myelin sheath that acts as insulation, the same way plastic coating around a wire protects the integrity and speed of the signal within. And, just like with a wire, destruction of insulation (demyelination) causes a short circuit and breakdown in signaling communication. Depending on the location of PML lesions in the brain, a variety of neurological symptoms can be present.
There is currently no treatment available for PML. All treatments are focused on reconstituting a PML patient's immune system, since a JCV-specific T-cell response is associated with PML survival.
Meet Our Team
The HIV Neurology Center is staffed by physicians who have received specialized training in this field and who are on the faculty at Harvard Medical School.
Igor J. Koralnik, MD
Professor of Neurology