Adaptation of antiretroviral therapy in human immunodeficiency virus infection with central nervous system involvement.
The authors describe a patient with known human immunodeficiency virus (HIV)-1 infection who presented with two generalized seizures and was found to have extensive white matter disease and a left/bilateral temporo-occipital focal slowing on electroencephalography (EEG). There were no magnetic resonance imaging (MRI) or cerebrospinal fluid (CSF) indications for opportunistic infection. Plasma viremia was controlled, whereas viral replication was uncontrolled in CSF. CSF-specific genotype-guided adaptation of the antiretroviral therapy in order to optimize central nervous system (CNS) penetration resulted in clinical improvement and normalization of MRI and EEG. Our case report illustrates the importance of individualized antiretroviral therapy in HIV infected patients with neurological complications.
Mehling
Matthias
M
Department of Neurology, University Hospital of Basel, Switzerland. mehlingm@uhbs.ch
Drechsler
Henning
H
Kuhle
Jens
J
Hardmeier
Martin
M
Doerries
Ruediger
R
Ruegg
Stephan
S
Gass
Achim
A
D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000145:classification / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D003521:Cyclopropanes; D016049:Didanosine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D019259:Lamivudine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D019888:Nelfinavir / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D019829:Nevirapine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D009842:Oligopeptides / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D063065:Organophosphonates / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D011725:Pyridines / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D019438:Ritonavir / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D018119:Stavudine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D000068698:Tenofovir; D019562:Viral Load; D014779:Virus Replication; D015215:Zidovudine / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use
D000480:Alkynes; D019380:Anti-HIV Agents; D000927:Anticonvulsants; D048588:Benzoxazines; D003521:Cyclopropanes; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D019259:Lamivudine; D015215:Zidovudine; D000069446:Atazanavir Sulfate; D019469:Indinavir; D019829:Nevirapine; D000068698:Tenofovir; D018119:Stavudine; D019888:Nelfinavir; D000225:Adenine; C098320:efavirenz; D016049:Didanosine; D019438:Ritonavir