title: Bypassing non-adherence via PEG in a critically ill HIV-1-infected patient.
abstract: This case study describes a 44-year-old, chronically non-adherent, HIV-infected male with relapsing, life threatening toxoplasmic encephalitis (TE) and other recurring opportunistic infections. Non-adherence resulted in critical illness, suppressed CD4 lymphocyte count and elevated viral load. In order to bypass the patient's complete psychological aversion to taking medication, and after exhausting various psychological interventions, a percutaneous endoscopic gastronomy (PEG) tube was inserted for delivery of indispensable medication. During the 15-month follow-up the patient was adherent, exhibiting a consistently undetectable viral load, high CD4 count and a remission of the opportunistic infections. This is an interesting case study demonstrating life-saving and long-term benefit of PEG in an exceptional setting, which has implications for future research and treatment of non-adherent HIV-infected patients.
authors.affiliation: Medizinische Poliklinik, Ludwig-Maximilians-University Munich, Munich, Germany. jan.leipe@med.uni-muenchen.de
authors.forename: J
authors.initials: J
authors.lastname: Leipe
authors.forename: A J
authors.initials: AJ
authors.lastname: Hueber
authors.forename: J
authors.initials: J
authors.lastname: Rech
authors.forename: T
authors.initials: T
authors.lastname: Harrer
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000279:Administration, Cutaneous; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D016638:Critical Illness; D005774:Gastrostomy / Q000295:instrumentation*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D008297:Male; D016781:Toxoplasmosis, Cerebral / Q000188:drug therapy; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents