Neuropsycological and Neuroimaging Outcome 3 of Hiv - Associated Progressive Multifocal Leukoencephalophathy in the Era of 5 Antiretroviral Therapy

Aims: The purpose of the present case is to describe the functional outcome of a patient 1 with human immunodeficiency virus (HIV) and progressive multifocal leukoencephalopa-thy (PML) on treatment with antiretroviral therapy using a multidisciplinary approach. 3 Methods: Neuropsychological tests and diffusion tensor imaging (DTI) were obtained at baseline and after 12 months to define the severity of white matter damage. Neuropsycho-5 logical and neuroimaging data were compared to an HIV-infected patient without PML and with good immune system health, and to a second HIV-infected patient without PML 7 but with notable immunosuppression. Results: Review of the HIV/PML patient's cognitive data at both time points revealed sig-9 nificant impairments compared to the control subjects. Similarly, the HIV/PML patient's white matter lesion load and whole brain volume were markedly different from the control 11 subjects at both time points. The tractography-defined metrics suggest significant white matter fiber loss associated with HIV/PML that was not evident in either HIV control 13 patient. Discussion: Our findings suggest that PML is associated with marked cognitive and 15 neuroimaging abnormalities in the context of antiretroviral therapy. Integrative Significance: To our knowledge this is the first study to integrate both 17 quantitative DTI and cognitive assessment to define white matter damage associated with HIV and PML. This integrative approach provides a robust methodology to examine the 19 integrity of brain systems mediating cognitive function.