title: HIV type 1 viral encephalitis after development of viral resistance to plasma suppressive antiretroviral therapy.
abstract: HIV-1 viral encephalitis produced by antiretroviral-resistant strains in cerebrospinal fluid (CSF), despite suppression of plasma HIV-1 RNA, has been rarely described. We report two cases of symptomatic viral encephalitis demonstrated by clinical, magnetic resonance imaging (MRI), and an inflammatory CSF profile. Viral load in CSF was 24,000 and 6850 copies/ml, whereas plasma HIV RNA level was undetectable since the beginning of therapy. A resistance test in CSF showed genotypic mutations confering resistance to the drugs the patients received for more than 2 years. In the two cases, a high baseline HIV RNA level, a low nadir CD4(+) count, and suboptimal CSF levels of atazanavir were considered as the risk factors for developing encephalitis. The two cases did not resolve with a change to antiretroviral drugs with better CNS penetration, but they had complete clinical and MRI recovery after changing to therapy considering both CNS viral resistance and penetration.
authors.affiliation: Department of Infectious Diseases, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. mariadelpalaciotamarit@yahoo.es
authors.forename: María del Palacio
authors.initials: Mdel P
authors.lastname: Tamarit
authors.forename: Carmen
authors.initials: C
authors.lastname: Quereda
authors.forename: Marta
authors.initials: M
authors.lastname: Gonzalez-Rozas
authors.forename: Iñigo
authors.initials: I
authors.lastname: Corral
authors.forename: José L
authors.initials: JL
authors.lastname: Casado
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000069446:Atazanavir Sulfate; D024882:Drug Resistance, Viral; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000821:virology; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects*; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate