title: Myelopathy in a previously asymptomatic HIV-1-infected patient.
abstract: A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients. The most common such condition is HIV-1-associated myelopathy (HM) which characteristically complicates advanced HIV-1 disease in patients with low CD4 cell counts and previous AIDS-defining diagnoses. We describe an unusual presentation of HM in a previously asymptomatic patient with a relatively preserved CD4 cell count (458 cells/mm3) who was even unaware of his serological status. The patient presented with a clinically severe, slowly progressive myelopathy and could not walk unassisted. Significant neurological improvement could be obtained as rapidly as within 4 weeks after the institution of an antiretroviral combination of only two nucleoside analog HIV-1 reverse transcriptase inhibitors (zidovudine and didanosine). An HIV-1 protease inhibitor was also prescribed at that point but could only be added to intensify the regimen 3 months later, when significant neurological improvement had already been recorded. We also review the disorders reported to derange spinal cord function in previously asymptomatic HIV-1-infected patients.
authors.affiliation: Dept of Clinical Immunology, Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, RJ, Brazil. walter-eyer@unirio.br
authors.forename: W A
authors.initials: WA
authors.lastname: Eyer-Silva
authors.forename: I
authors.initials: I
authors.lastname: Auto
authors.forename: J F
authors.initials: JF
authors.lastname: Pinto
authors.forename: C A
authors.initials: CA
authors.lastname: Morais-de-Sá
mesh_terms: D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013118:Spinal Cord Diseases / Q000188:drug therapy / Q000209:etiology / Q000821:virology*; D016896:Treatment Outcome
chemical_list: D018894:Reverse Transcriptase Inhibitors