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Abnormal Brain MRI - no symptoms
May 28, 2008

I am asymptomatic and undetectable for 10 years, never sick. I had a brain MRI for headaches, and was told I have "diffuse severe white matter changes" which could be MS or other chronic disease. I don't have MS, and I have no neuro symptoms. Can this be simply from chronic HIV, and what can I do about it? Is it a "sign" of anything to come? Thanks.

Response from Dr. McGowan

MRI is a technique for imaging the brain that is very sensitive. Like any test or examination, the results of an MRI must be interpreted in relation to the patient's particular case. Many of the findings on an MRI may not be diagnostic of any disease but reflect a variety of normal. HIV itself can cause abnormalities on MRI scans. HIV usually causes changes in the "white matter" of the brain. The "white matter" contains the connections between the brain cells (like the wiring of the brain). The "grey matter" contains the cell bodies of the nerve cells (neurons) of the brain. There are many opportunistic conditions and infections, such as PML (progressive multifocal leukoencephalopathy), toxoplasmosis, lymphomas, tuberculosis and others that can cause abnormalities in the brain in people with HIV, but these usually occur when the CD4 count is low, unlike in your case. HIV medications will penetrate into the brain differently, and this can be related to the degree that HIV is controlled in the brain and spinal cord. It would be very important to work closely with your doctors to monitor these changes carefully, have a complete neurologic and cognitive (memory/comprehension) evaluation and have a directed work up to rule out MS and other conditions (like PML) that could be causing these findings. If nothing shows up, it may be from HIV, and maintaining a suppressed viral load with a cocktail with good brain penetration would be the best treatment. I hope all turns out well,

Joe


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