Abstract: AIDS patients are prone to central nervous system infection due to decreased immunity, and JC virus infection can lead to progressive multifocal leukoencephalopathy (PML). There is no specific treatment for this disease, and before the advent of antiviral therapy (HARRT), the case fatality rate was extremely high. This article reports a young male patient who developed symptoms of unilateral limb numbness and progressively worsened numbness in the hind limbs. He was initially screened positive for HIV antibodies and admitted to the hospital. Previously healthy with no underlying diseases. After admission, CD4⁺T lymphocytescount was 30 cells/µl, 6.64×10⁴ copies/ml of HIV RNA in blood, 5.16×10³ copies/ml of HIV RNA in cerebrospinal fluid, and JC virus was detected by metagenomic second-generation sequencing (mNGS) in cerebrospinal fluid. Combined with the MRI findings of the patient's head, PML caused by AIDS was clinically diagnosed. After early initiation of HARRT, the patient's limb function gradually recovered and returned to normal life. Through this case, the clinical characteristics, imaging manifestations and antiviral treatment plan of AIDS combined with PML are discussed in this paper, aiming to improve the vigilance of clinicians. When HIV patients have neurological dysfunction, it is necessary to determine whether PML is combined or not, and early initiation of HARRT can improve the prognosis of patients.

Key words: Acquired immune deficiency syndrome, Progressive multifocal leukoencephalopathy, Metagenomic second-generation sequencing, Antiviral therapy