title: Human herpesvirus 6-associated retrobulbar optic neuritis in an HIV-infected patient: response to anti-herpesvirus therapy and long-term outcome.
abstract: Like other herpesviruses, human herpesvirus 6 (HHV-6) can reactivate in immunocompromised patients. A case is described of an HIV-1-infected patient who developed bilateral retrobulbar optic neuritis associated with HHV-6 infection. A 59-year-old woman, infected with HIV for 18 years, interrupted antiretroviral treatment because of therapeutic failure and severe metabolic complications. She presented subsequently with blurred vision and ophthalmological examination showed visual loss due to optic neuritis. Her CD4+ count was 285 cells/mm(3) and her plasma HIV-1 RNA level was 5.5 log(10) copies (cp)/ml. Magnetic resonance imaging of the brain was normal. HHV-6 loads were 3.2 log cp/ml in cerebrospinal fluid (CSF) and 6.3 log cp/10(6) peripheral blood mononuclear cells. Combined intravenous treatment was started with foscarnet and ganciclovir then changed to cidofovir and long-term valganciclovir. Her ocular condition improved gradually despite little decrease of the HHV-6 load in the CSF. Salvage antiretroviral treatment was then administered, with marked immunological and virological responses, contributing to further progressive ocular improvement. HHV-6-related optic neuritis has not been described previously in HIV-infected patients. Anti-HHV-6 treatment improved the patient's vision, but immune restoration seems to remain essential for long-term recovery.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, Bicêtre University Hospital, Le Kremlin Bicêtre Cedex, France. mechaifrederic@wanadoo.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Méchaï
authors.forename: David
authors.initials: D
authors.lastname: Boutolleau
authors.forename: Véronique
authors.initials: V
authors.lastname: Manceron
authors.forename: Jacques
authors.initials: J
authors.lastname: Gasnault
authors.forename: Yann
authors.initials: Y
authors.lastname: Quertainmont
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Brosseau
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: Marc
authors.initials: M
authors.lastname: Labetoulle
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000821:virology; D000998:Antiviral Agents / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000821:virology; D005260:Female; D015497:HIV-1; D015654:Herpesvirus 6, Human / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D008875:Middle Aged; D009902:Optic Neuritis / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D019349:Roseolovirus Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology
chemical_list: D000998:Antiviral Agents