Highly Active Antiretroviral Therapy and Gamma Knife Radiosurgery for the Treatment of AIDS-Related Primary Central Nervous System Lymphoma: A Case Report.

A 66-year-old male presented with acute cephalalgia, disorientation, and lethargy. The patient was evaluated in the ER and admitted with probable hydrocephalus. Brain-MRI revealed multiple nonspecific brain lesions, predominantly involving the right temporal lobe, which on biopsy proved a diagnosis of Primary Central Nervous System Lymphoma (PCNSL). Subsequent laboratory studies demonstrated active HIV infection with a CD4 count of 21 cells/ microliter and HIV viral load (VL) of greater than 400,000 copies/milliliter. The patient was eventually initiated on highly active antiretroviral therapy (HAART). He declined palliative whole-brain radiotherapy (WBRT) but was amenable to Gamma Knife Radiosurgery (GKRS) for treatment of right temporal brain lesions. Three months later, the patient's neurological symptoms improved; similarly, his CD4 count increased to 176 cells/mL and his HIV VL was less than 90 copies/mL. By 12-month follow-up, patient was asymptomatic and at 36-months, Brain MRI demonstrated total remission (CR) without new brain lesions. The gold standard treatment of newly diagnosed PCNSL remains high-dose chemotherapy in conjunction with palliative WBRT, however there may be a role for novel, combined approaches utilizing chemotherapy, HAART, and GKRS to positively impact survival rates of PCNSL related to AIDS.