title: CD8 encephalitis in HIV-infected patients receiving cART: a treatable entity.
abstract: BACKGROUND
  Despite its overall efficacy, combined antiretroviral therapy (cART) has failed to control human immunodeficiency virus (HIV) infection of the central nervous system (CNS). New acute and chronic neurological complications continue to be reported.
  
  
  METHODS
  We conducted a retrospective study of 14 HIV-infected patients with documented encephalitis, which was initially attributed to an undetermined origin. Brain magnetic resonance imaging (MRI) uniformly revealed unusual, multiple linear gadolinium-enhanced perivascular lesions.
  
  
  RESULTS
  All patients had manifested acute or subacute neurological symptoms; the brain MRIs indicating diffuse brain damage. The mean duration of HIV infection was approximately 10 years, and 8 patients were immunovirologically stable. Cerebrospinal fluid abnormalities with mildly elevated protein and pleocytosis with >90% lymphocytes, predominantly CD8, were found in all but 1 patient. The mean cerebral spinal fluid HIV load was 5949 copies/mL. Six patients reported a minor infection a few days prior to neurological symptoms, 2 patients presented criteria for the immune reconstitution inflammatory syndrome of the CNS, 2 were in virological escape, and 1 developed encephalitis after interruption of cART. Brain biopsies revealed inflammatory encephalitis associated with astrocytic and microglial activation as well as massive perivascular infiltration by polyclonal CD8(+) lymphocytes. All patients had been treated with glucocorticosteroids. The long-term therapeutic response varied from excellent, with no sequalae (n = 5), to moderate, with cognitive disorders (n = 4). The mean survival time was 8 years; however, 5 patients died within 13 months of initiation of treatment.
  
  
  CONCLUSIONS
  CD8 encephalitis in HIV-infected patients receiving cART is a clinical entity that should be added to the list of HIV complications.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, AP-HP, Hôpital Tenon, Paris, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lescure
authors.forename: Antoine
authors.initials: A
authors.lastname: Moulignier
authors.forename: Julien
authors.initials: J
authors.lastname: Savatovsky
authors.forename: Corinne
authors.initials: C
authors.lastname: Amiel
authors.forename: Guislaine
authors.initials: G
authors.lastname: Carcelain
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Molina
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gallien
authors.forename: Jérôme
authors.initials: J
authors.lastname: Pacanovski
authors.forename: Gilles
authors.initials: G
authors.lastname: Pialoux
authors.forename: Homa
authors.initials: H
authors.lastname: Adle-Biassette
authors.forename: Françoise
authors.initials: F
authors.lastname: Gray
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000821:virology; D004660:Encephalitis / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008218:Lymphocytosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000893:Anti-Inflammatory Agents; D044966:Anti-Retroviral Agents; D005938:Glucocorticoids
keywords: CD8 lymphocytes; HIV; central nervous system; encephalitis; glucocorticosteroids