Abi Manesh1, Rohit Barnabas2, Sunithi Mani3, Rajiv Karthik1, O C Abraham2, Geeta Chacko4, Rajesh Kannangai5, George M Varghese6. 1. Department of Infectious Diseases, Christian Medical College, Vellore, India. 2. Department of Medicine, Christian Medical College, Vellore, India. 3. Department of Radiology, Christian Medical College, Vellore, India. 4. Department of Pathology, Christian Medical College, Vellore, India. 5. Department of Clinical Virology, Christian Medical College, Vellore, India. 6. Department of Infectious Diseases, Christian Medical College, Vellore, India. Electronic address: georgemvarghese@hotmail.com.
Abstract
OBJECTIVE: The clinical syndrome in symptomatic HIV associated CNS viral escape is poorly defined. We attempted to describe the clinical syndrome, laboratory profile, radiological features and outcomes of HIV infected patients with symptomatic central nervous system (CNS) viral escape in our study. METHODS: This is a retrospective study were adult patients with HIV infection on cART admitted with a diagnosis of CD8 encephalitis or CNS viral escape in a large teaching hospital in South India was identified. RESULTS: The mean age of the eleven patients included in the study was 37.5 years. Most patients had received almost a decade of antiretroviral treatment at diagnosis (mean: 11.18 years). All patients presented with global cerebral syndrome. Cognitive decline, tremors, and headaches were common manifestations. All patients had lymphocytic pleocytosis (mean cell count: 44.63 cells/ml; lymphocyte percentage: 94.81%) with elevated protein (mean: 125.36 mg/dl). All patients were on boosted protease inhibitors (81.8% on Atazanavir and 18.18% Lopinavir). All except one patient was on Tenofovir and lamivudine combination therapy. White matter changes and deep brain nuclei involvement were common. Most patients required a change of cART to regimens with better CNS penetration and suppression of the resistant virus in the plasma and improved. CONCLUSION: CNS viral escape should be considered as a differential among patients on Atazanavir presenting with non-focal cerebral syndrome and CSF lymphocytic pleocytosis.
OBJECTIVE: The clinical syndrome in symptomatic HIV associated CNS viral escape is poorly defined. We attempted to describe the clinical syndrome, laboratory profile, radiological features and outcomes of HIV infectedpatients with symptomatic central nervous system (CNS) viral escape in our study. METHODS: This is a retrospective study were adult patients with HIV infection on cART admitted with a diagnosis of CD8encephalitis or CNS viral escape in a large teaching hospital in South India was identified. RESULTS: The mean age of the eleven patients included in the study was 37.5 years. Most patients had received almost a decade of antiretroviral treatment at diagnosis (mean: 11.18 years). All patients presented with global cerebral syndrome. Cognitive decline, tremors, and headaches were common manifestations. All patients had lymphocytic pleocytosis (mean cell count: 44.63 cells/ml; lymphocyte percentage: 94.81%) with elevated protein (mean: 125.36 mg/dl). All patients were on boosted protease inhibitors (81.8% on Atazanavir and 18.18% Lopinavir). All except one patient was on Tenofovir and lamivudine combination therapy. White matter changes and deep brain nuclei involvement were common. Most patients required a change of cART to regimens with better CNS penetration and suppression of the resistant virus in the plasma and improved. CONCLUSION: CNS viral escape should be considered as a differential among patients on Atazanavir presenting with non-focal cerebral syndrome and CSF lymphocytic pleocytosis.
Authors: Sérgio Monteiro de Almeida; Indianara Rotta; Ana Paula de Pereira; Bin Tang; Anya Umlauf; Cléa Elisa Lopes Ribeiro; Scott Letendre; Ronald J Ellis Journal: J Neurovirol Date: 2020-01-30 Impact factor: 2.643
Authors: Nametso Kelentse; Sikhulile Moyo; Kesaobaka Molebatsi; Olorato Morerinyane; Shatho Bitsang; Ontlametse T Bareng; Kwana Lechiile; Tshepo B Leeme; David S Lawrence; Ishmael Kasvosve; Rosemary Musonda; Mosepele Mosepele; Thomas S Harrison; Joseph N Jarvis; Simani Gaseitsiwe Journal: Biomedicines Date: 2022-06-13
Authors: Ameet N Dravid; Raviraj Gawali; Tarun P Betha; Avadesh K Sharma; Mahenderkumar Medisetty; Kartik Natrajan; Milind M Kulkarni; Chinmay K Saraf; Uma S Mahajan; Sachin D Kore; Niranjan M Rathod; Umakant S Mahajan; Scott L Letendre; Rustom S Wadia; Andrea Calcagno Journal: Medicine (Baltimore) Date: 2020-06-12 Impact factor: 1.817