title: HIV encephalitis despite suppressed viraemia: a case of compartmentalized viral escape.
abstract: There is increasing concern that HIV treatment failure may result from inadequate central nervous system (CNS) penetration of antiretroviral drugs, allowing compartmentalized viral replication and development of resistance. We discuss a patient who maintained a suppressed plasma viral load for four years on antiretroviral therapy (ART) before developing HIV encephalitis with a cerebrospinal fluid (CSF) HIV viral load of 861 copies/mL and newly detectable plasma viral load of 68 copies/mL. Identification of major resistance mutations to his combination therapy supported concerns that resistant HIV had developed within the CNS. His ART was changed to optimize CNS penetration, leading to maintained clinical improvement. Imaging presented demonstrates corresponding radiological improvement. The report illustrates the need to exclude CNS viral rebound or incomplete suppression in HIV patients with neurological symptoms, and suggests that the extent of this emerging problem is only beginning to be recognized as the implications of long-term peripheral HIV suppression unfold.
authors: Department of Thoracic & HIV Medicine, Royal Free Hospital, London, UK. rachelbingham@nhs.net
authors: R
authors: R
authors: Bingham
authors: N
authors: N
authors: Ahmed
authors: P
authors: P
authors: Rangi
authors: M
authors: M
authors: Johnson
authors: M
authors: M
authors: Tyrer
authors: J
authors: J
authors: Green
mesh_terms: D015526:AIDS Dementia Complex / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000821:virology*; D000328:Adult; D019380:Anti-HIV Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D011859:Radiography; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000821:virology; D014779:Virus Replication
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral