Herpes simplex virus (HSV) can affect the central nervous system causing meningitis, encephalitis and, rarely, acute retinal necrosis. We present a case of a 46-year-old man, previously healthy complaining of a 5-day persistent headache and sudden loss of vision of his left eye that progressed to the right. We started ceftriaxone, methylprednisolone and acyclovir for suspected encephalitis with vasculitis. HSV-1 was identified in vitreous and aqueous humour. Therapy with acyclovir was maintained and two intravitreous boluses of foscarnet were administered, without improvement. Usually being a benign infection, HSV can, in rare cases like this, have catastrophic effects in the optic tract.
Aim
Antiretroviral therapy (ART) development has reduced the severity of neurological complications of the human immunodeficiency virus (HIV), but they remain prevalent and need prompt recognition. Acute inflammatory demyelinating polyneuropathy (AIDP) is a rare complication of human immunodeficiency virus (HIV) infection that may appear at any stage of the disease. In this case, AIDP represents a late presentation of HIV infection.
Methods
Descriptive study. Patient data were collected from their medical records and by health assessment interviews.
Results
We report a case of a 52-year-old male with acute lower limb weakness. Given the suggestive clinical presentation of AIDP and a positive HIV test, intravenous immunoglobulin (IVIG) was administered along with antiretroviral therapy. Progressive weakness to the upper limbs, autonomic dysfunction, and pain was observed. The second regimen of IVIG plus corticosteroids was administered. Muscle strength improved after three weeks.
Conclusions
Screening for HIV in a patient with AIDP may provide a better outcome because of the early start of ART with good central nervous system penetration in HIV-infected patients.
Background and Aims:
Risk of liver-related morbidity and mortality is not eliminated in cirrhotic patients following direct-acting antiviral treatment. This study aimed to assess virologic and clinical outcomes among chronic hepatitis C patients who received sofosbuvir (SOF)-based regimens.
Methods:
Non-interventional, multicenter,retrospective, single-cohort study of 1,724 patients who started treatment with (SOF)-based regimens between February 2015 and August 2016. SVR12, liver fibrosis, mortality and progression disease risks scores were evaluated.
Results:
Patients median age was 51.9 years and 71.7% were male. Most patients (67.2%) were genotype (GT) 1. Cirrhosis was found in 35.5% of patients being 94.8% compensated. Ledipasvir/SOF was the most common regimen (76.1%) and 20.2% of patients received ribavirin (RBV).SVR12 was 97.7%, higher among females (99.0%; p=0.0298) and patients withoutRBV (98.8%; p=0.0002). SVR12 were approximately 97% among patients with and without extra-hepatic comorbidities (EHC) and in cirrhotic patients. At 24 weeks after treatment cessation, liver fibrosis stage improvement was observed in 45.2% of patients and was higher in SVR12 patients without EHC than with EHC (53.8% vs 37.9%, p=0.0227). At baseline, the 2.5 years median mortality risk was lower among patients without EHC than with EHC (1.6% vs 1.8%; p=0.0043). Same trend was found regarding 5 and 7.5-year risk at baseline and at 12 weeks follow up.
Discussion/Conclusion:
SOF-based regimens showed high SVR rates in all genotypes, being higher among females and those not receiving RBV. Nearly half of patients improved liver fibrosis stage over time. Presence of EHC may lead to poorer prognosis in terms of liver fibrosis, morbidity and all-cause mortality risk.
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