title: [HIV encephalopathy due to drug resistance despite 2-year suppression of HIV viremia by cART].
abstract: A 57-year-old man presented with subacute progression of cognitive impairment (MMSE 22/30). He had been diagnosed as AIDS two years before and taking atazanavir, abacavir, and lamivudine. HIV RNA of plasma had been negative. On admission, HIV RNA was 4,700 copy/ml and 5,200 copy/ml in plasma and in cerebrospinal fluid respectively, suggesting treatment failure of cART. The brain magnetic resonance imaging showed high intensity areas in the white matter of the both frontal lobes and brain stem. The drug-resistance test revealed the resistance of lamivudine and abacavir. We introduced the CNS penetration effectiveness (CPE) score to evaluate the drug penetration of HIV drugs. As the former regimen had low points (7 points), we optimized the regimen to raltegravir, zidovudine, and darunavir/ritonavir (scoring 10 points). His cognitive function improved as normal (MMSE 30/30) in 2 weeks and HIV-RNA became undetectable both in plasma and CSF in a month. In spite of the cognitive improvement, the white matter hyperintensity expanded. To rule out malignant lymphoma or glioblastoma, the brain biopsy was performed from the right frontal lobe. It revealed microglial hyperplasia and diffuse perivascular infiltration by CD8+/CD4-lymphocytes. No malignant cells were found and the polymerase chain reaction analyses excluded other viruses. Considering the drug penetration to the central nervous system is important for treating HIV encephalopathy.
authors.affiliation: Department of Neurology, Kobe City Medical Center General Hospital.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sekiya
authors.forename: Michi
authors.initials: M
authors.lastname: Kawamoto
authors.forename: Masaya
authors.initials: M
authors.lastname: Togo
authors.forename: Hajime
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imai
authors.forename: Nobuo
authors.initials: N
authors.lastname: Kohara
mesh_terms: D015526:AIDS Dementia Complex / Q000821:virology*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D002490:Central Nervous System / Q000378:metabolism; D003072:Cognition Disorders / Q000821:virology; D000069454:Darunavir; D018450:Disease Progression; D024882:Drug Resistance, Viral; D057915:Drug Substitution; D006678:HIV / Q000187:drug effects* / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011760:Pyrrolidinones / Q000008:administration & dosage; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D000068898:Raltegravir Potassium; D019438:Ritonavir / Q000008:administration & dosage; D013449:Sulfonamides / Q000008:administration & dosage; D013997:Time Factors; D014766:Viremia / Q000188:drug therapy*; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D044966:Anti-Retroviral Agents; D011760:Pyrrolidinones; D012367:RNA, Viral; D013449:Sulfonamides; D000068898:Raltegravir Potassium; D015215:Zidovudine; D019438:Ritonavir; D000069454:Darunavir