HIV encephalitis related to the development of a discordant resistant virus in CNS

Pérez-Rodríguez, M. Teresa; Sousa, Adrián; Martínez-Cueto, P.; Ocampo, Antonio

doi:10.1016/j.cmi.2015.05.003

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…Active management was recommended for cases with symptomatic CSF HIV escape [ 6 ]. The neurosymptomatic CSF HIV escape with drug resistance mutations requires ART adjustment according to genotypic drug resistance results from both CSF and plasma, because the discordance of resistance patterns in different biologic compartments has been reported [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Learning from cerebrospinal fluid drug-resistant HIV escape-associated encephalitis: a case report

Kang,

Wang,

Zhou

et al. 2023

Virol J

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Background In the era of antiretroviral therapy (ART), central nervous system (CNS) complications in patients with human immunodeficiency virus (HIV) infection are sometimes associated with cerebrospinal fluid (CSF) viral escape. Here, we reported a case of persistent CNS viral escape with recurrent symptomatic encephalitis, which had ultimate stabilization achieved by a combination of ART adjustment and corticosteroids. Case presentation A 27-year-old man with HIV infection complained of recurrent headaches during the last year. His magnetic resonance imaging (MRI) presented diffused bilateral white matter lesions, and laboratory tests confirmed elevated CSF protein level, lymphocytic pleocytosis, and detectable CSF HIV RNA (774 copies/mL). Plasma HIV RNA was well suppressed with tenofovir, lamivudine, and lopinavir/ritonavir. Prednisone 60 mg once daily was initiated to reduce intracranial inflammation, followed by a good clinical response, with CSF HIV RNA still detectable (31.1 copies/mL). During the gradual tapering of prednisone, his headache relapsed, and booming viral loads were detected in both CSF (4580 copies/mL) and plasma (340 copies/mL) with consistent drug-resistant mutations. Thereupon, prednisone was resumed and the ART regimen was switched to zidovudine, lamivudine, and dolutegravir according to drug resistance tests. Persistent clinical recovery of symptoms, neuroimaging, and laboratory abnormalities were observed in the follow-up visits. Conclusion CSF and plasma HIV RNA and further drug resistance tests should be monitored in HIV-infected patients with neurologic symptoms, as opportunistic infections or tumors can be ruled out. ART optimization using a sensitive regimen may be crucial for addressing CSF viral escape and the related encephalitis.

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Section: Discussionmentioning

confidence: 99%

Learning from cerebrospinal fluid drug-resistant HIV escape-associated encephalitis: a case report

Kang,

Wang,

Zhou

et al. 2023

Virol J

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Lopinavir/ritonavir

2015

Reactions Weekly

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S Lopinavir/ritonavir HIV encephalitis after acquiring intermediate resistance: case reportA 45-year-old man developed HIV encephalitis after acquiring intermediate resistance to lopinavir during treatment with lopinavir/ritonavir. The man, who had been diagnosed with a wild-type HIV-1 genotype acquired immunodeficiency syndrome, was receiving antiretroviral therapy (ART) with lopinavir/ritonavir [route and dosages not stated], abacavir and lamivudine. His viral load was kept under control (<20 copies/mL) and CD4 count was 700 cells/mL. At admission, his neurologic examination revealed drowsiness, confusion and bilateral Babinski sign for 3 months. During the first 24 hours, he experienced generalised tonic-clonic seizures without recovering consciousness and electroencephalographic studies showed a left frontoparietal partial status epilepticus. He was transferred to ICU where CSF analysis revealed 20 leukocytes/µL, 47 RBCs/µL, glucose 59 mg/dL and proteins 51 mg/dL. The HIV virus load in the plasma and the CSF at that time were 56 copies/mL and 28400 copies/mL, respectively. A discordance of resistance patterns between CSF and plasma was noted. An intermediate resistance to lopinavir was detected in CSF. A brain MRI revealed hyperintensity on T2weighted images and isointensity on T1-weighted images, without enhancements, of the periventricular white matter, corpus callosum, left basal ganglia and middle cerebellar peduncles.According to the resistance studies, the man's ART was changed to darunavir/ritonavir, raltegravir, etravirine, abacavir and maraviroc. At follow-up after 29 months, he was noted asymptomatic with CSF virus load <20 copies/mL and with resolved CNS lesions.Author comment: "[I]ntermediate resistance to fosamprenavir, indivavir, lopinavir and nefinavir and low-level resistance to darunavir were detected in CSF." "In conclusion, HIV encephalitis should not be excluded in patients with neurologic symptoms, CSF pleocytosis and white matter hyperintensities on MRI even when plasma virus load is <20 copies/mL." Perez-Rodriguez MT, et al. HIV encephalitis related to the development of a discordant resistant virus in CNS. Clinical Microbiology and Infection 21: e59-e60, No. 8, Aug 2015. Available from: URL: http://doi.

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What can characterization of cerebrospinal fluid escape populations teach us about viral reservoirs in the central nervous system?

Joseph

Trunfio

Kincer

et al. 2019

Aids

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HIV encephalitis related to the development of a discordant resistant virus in CNS

Cited by 3 publications

References 4 publications

Learning from cerebrospinal fluid drug-resistant HIV escape-associated encephalitis: a case report

Learning from cerebrospinal fluid drug-resistant HIV escape-associated encephalitis: a case report

Lopinavir/ritonavir

What can characterization of cerebrospinal fluid escape populations teach us about viral reservoirs in the central nervous system?

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