# Progressive Multifocal Leukoencephalopathy in Patients with HIV—Case Series from Northeastern Romania

## TL;DR

This paper presents three HIV cases from Romania where patients developed a severe brain disease caused by a virus, highlighting the need for early HIV testing and multidisciplinary care.

## Contribution

The study provides a case series from northeastern Romania emphasizing PML in HIV patients and the importance of multidisciplinary care.

## Key findings

- Three HIV patients presented neurological symptoms and were diagnosed with PML via MRI and JCV PCR testing.
- All cases showed low CD4 levels and high HIV viremia, indicating advanced immunosuppression.
- A multidisciplinary approach involving neurology and adherence to antiretroviral treatment is crucial for managing such cases.

## Abstract

Background: Human polyomavirus JC (JCV) causes progressive multifocal leukoencephalopathy (PML), a deadly brain demyelinating illness stemming from oligodendrocyte lytic infection in immunocompromised patients, especially those with untreated HIV infection. Methods: We conducted a case series report on patients with HIV/AIDS who presented progressive multifocal leukoencephalopathy and were hospitalized at the “St. Parascheva” Clinical Hospital of Infectious Diseases in Iasi, northeastern Romania, to emphasize the comorbidities of HIV/AIDS cases. Hospital medical data from 10 January 2025 to 30 September 2025 served as the basis for this investigation. Results: We examined three cases that presented neurological symptoms (ataxia, aphasia, language comprehension, and expression disorders). The cases were evaluated imagistically via nuclear magnetic resonance, and we conducted a polymerase chain reaction test on the spinal fluid to confirm the presence of JCV. It was necessary to take a multidisciplinary approach with a neurologist or pneumologist. All cases were evaluated immunologically, revealing low Ly T CD4 levels and increased HIV viremia levels. Progressive multifocal leukoencephalopathy is an AIDS-defining disease, manifesting in immunocompromised patients, including late presenter cases, and patients who are non-adherent to their antiretroviral treatment. Therefore, it is important to test every patient who has mild to severe neurological symptoms for HIV. Furthermore, some cases require a multidisciplinary approach to ensure a better quality of life. Conclusions: Treating a patient with HIV requires a multidisciplinary strategy that includes a neurology specialist and access to antiretroviral treatment. To boost ART uptake, we must identify and remove barriers that impact patients and the healthcare system.