CD8 Encephalitis Caused by Persistently Detectable Drug-resistant HIV

Abstract

We herein report a 52-year-old man infected with human immunodeficiency virus (HIV) who was referred to our hospital due to the development of severe neurocognitive disorders and bilateral leukoencephalopathy. He has been treated with antiretroviral agents for 17 years, but low-level viremia has been detected consistently prior to admission. Drug resistant testing of the serum and the cerebrospinal fluid (CSF) both demonstrated a M184V mutation. A brain biopsy revealed perivascular CD8 + T-lymphocyte infiltration, leading to the diagnosis of CD8 encephalitis. The clinical symptoms improved drastically after changing to a nucleoside reverse transcriptase inhibitor sparing regimen, which subsequently decreased the HIV viral load to an undetectable level in both the serum and CSF.

CD8 encephalitis with CSF EBV viraemia and HIV drug resistance, a case series

“…Presenting signs and symptoms of CD8 encephalitis can include headache, confusion and seizures ( Lescure et al., 2013 ), though ataxia and slurred speech have also been described ( Salam et al., 2016 ). Triggers for the condition have been postulated to include infection, immune reconstitution inflammatory syndrome (IRIS) and HIV viral escape in the CSF as a result of poor ART adherence, viral mutation or other causes ( Lescure et al., 2013 ; Morioka et al., 2016 ). A genetic component is believed to play a role as the condition seems to predominantly affect black Africans ( Lescure et al., 2013 ; Miller et al., 2004 ).…”

Progressive hemispheric atrophy in HIV: A Rasmussen's‐like variant of CD8 encephalitis?

“…In descriptions of CD8E, microglial activation, gliosis, diffuse parenchymal and perivascular infiltrates of polyclonal CD8 > CD4 T cells involve primarily the white matter [1–3] but with bilateral involvement on histology and MRI [3, 4]. Although cortical involvement is recognised [2, 5, 6], this does not seem to be preferentially targeted and the extensive, progressive and lateralised cortical destructive lesions observed in the current cases are not typical features. Recognised triggers for CD8E include CNS Immune reconstitution inflammatory syndrome (IRIS), virological ‘escape’ (with increased CSF VL), trivial systemic infections (including in well‐controlled patients) or interruptions to ARV treatment [2, 3, 7].…”

Biotypes of HIV-associated neurocognitive disorders based on viral and immune pathogenesis

“…1 and reviewed in [43]). IRIS specifically occurs after ART initiation (reviewed in [44–46]) whereas HIV-associated CD8 encephalitis can occur at any time and has been observed in patients who are well controlled on ART, treatment-naive, or as an IRIS event [28 ▪▪ ,47,48].…”