HIV-2 encephalitis: case report and literature review.
We report the case of a 59-year-old man who moved from Cape Verde to Massachusetts at the age of 29. He had multiple sexual contacts with female partners in Cape Verde and with West African women in Massachusetts, as well as multiple past indeterminate HIV-1 antibody tests. He presented to our facility with 2-3 months of inappropriate behaviors, memory impairment, weight loss, and night sweats, at which time he was found to have an abnormal enhancing lesion of the corpus collosum on brain magnetic resonance imaging (MRI). Laboratory testing revealed a CD4 count of 63 cells/mm(3), positive HIV-2 Western blot, serum HIV-2 RNA polymerase chain reaction (PCR) of 1160 copies per milliliter and cerebrospinal fluid (CSF) HIV-2 RNA PCR of 2730 copies per milliliter. Brain biopsy demonstrated syncytial giant cells centered around small blood vessels and accompanied by microglia, which correlated with prior pathologic descriptions of HIV-2 encephalitis and with well-described findings of HIV-1 encephalitis. Based on genotype resistance assay results, treatment guidelines, and prior studies validating success with lopinavir-ritonavir, he was treated with tenofovir-emtricitabine and lopinavir-ritonavir, which has led to virologic suppression along with steady neurologic and radiologic improvement, although he continues to have deficits.
Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. bwood2@partners.org
Brian R
BR
Wood
Joshua P
JP
Klein
Jennifer L
JL
Lyons
Danny A
DA
Milner
Richard E
RE
Phillips
Martin
M
Schutten
Rebecca D
RD
Folkerth
Pedro
P
Ciarlini
Timothy J
TJ
Henrich
Jennifer A
JA
Johnson
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology* / Q000821:virology*; D018791:CD4 Lymphocyte Count; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004338:Drug Combinations; D000068679:Emtricitabine; D018792:Encephalitis, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D015498:HIV-2 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D061466:Lopinavir / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage; D012367:RNA, Viral / Q000302:isolation & purification; D019438:Ritonavir / Q000008:administration & dosage; D000068698:Tenofovir; D019562:Viral Load
D019380:Anti-HIV Agents; D004338:Drug Combinations; D063065:Organophosphonates; D012367:RNA, Viral; C558899:lopinavir-ritonavir drug combination; D003841:Deoxycytidine; D061466:Lopinavir; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine; D019438:Ritonavir