Annals of Indian Academy of Neurology
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Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 220-222

Successful treatment of human immunodeficiency virus-associated highly active antiretroviral therapy-resistant vacuolar myelopathy with intravenous immunoglobulin

1 N.P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences, Saint-Petersburg, Russia
2 Saint Petersburg Center for Control of AIDS and Infectious Diseases, Saint-Petersburg, Russia

Correspondence Address:
Dr. Lidiia N Prakhova
Akad, Pavlov Street, 12a, Saint-Petersburg 197376
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_255_18

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For the first time, human immunodeficiency virus (HIV)-associated vacuolar myelopathy (VM) was detailed in an autopsy-based study of 89 cases in 1985. This condition is the most common cause for spinal cord lesions in HIV patients. VM's pathogenic mechanism remains unclear; however, it is assumed that the disease can be related to both, the direct neurotoxic impact of the HIV and HIV-induced activation of immunopathological processes in the central nervous system (CNS). Reviewed in this paper is a case where the VM presentation deteriorated drastically when treated with highly active antiretroviral therapy, and almost completely regressed after the patient received the intravenous immunoglobulin (IVIg) treatment. The considered case demonstrates the viability of IVIg treatment in patients with HIV-associated CNS pathology, particularly when autoimmune reactions are suspected. The results of placebo-controlled studies of IVIg in patients with HIV-associated myelopathy may give a reliable evaluation of IVIg use in this context.

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