DON'T BE REASSURED BY AN UNDETECTABLE SERUM HIV VIRAL LOAD. Issue 10 (9th September 2014)

• Record Type: Journal Article
• Authors: Shanmugarajah, Priya; Weerasinghe, Kalani; Warren, Daniel; Ford, Helen
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 85:Issue 10(2014)
• Page Start: e4
• Page End: e4
• Publication Date: 2014-09-09
• Subjects: EPILEPSY; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2014-309236.122
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : The immunologically privileged CNS can act as a reservoir for HIV-1 replication and mutation. Antiretrovirals can differ in their CNS penetration. Patients on HAART with serologically undetectable HIV-1 viral load can present with new neurological symptoms. A 48 year-old right-handed woman with a 4 year history of HIV, presented with focal motor and secondary generalised seizures, a week after alteration of established HAART. She had previous VZV encephalitis and HIV-associated neurocognitive disorder. The CD4 count was 212 with undetectable serum HIV-1 viral load. However, HIV-1 viral copies were detectable in the CSF. Extensive investigations excluded opportunistic infection and neoplasm. MRI demonstrated a progressive leucoencephalopathy; CT-angiography revealing intracranial angiitis with multifocal arterial aneurysm formation. She was treated with high-dose IV steroids and reducing oral steroids. We reinstated nevirapine and zidovudine was added to the high CNS penetrative HAART regime. HIV-1 viral copies were undetectable on repeat CSF. She had no further seizures but she remained dependent for ADLs. We postulate that the acute intracranial angiitis was secondary to neuro-IRIS following a change in the HAART treatment. This case illustrates the importance of recognizing the CNS as a HIV reservoir and the possibility of neuro-IRIS occurring at later stages of the disease.