HSV-1 encephalitis complicated by cerebral hemorrhage in an HIV-positive person

Although herpes simplex virus type 1 (HSV-1) is the most common cause of sporadic encephalitis in immunocompetent adults, it is an unusual cause of encephalitis in patients with HIV/AIDS. We report the case of a 56-year-old man with recently diagnosed HIV infection who presented with subacute mental status changes, fever, and temporal lobe abnormalities evident on brain imaging. Results of a polymerase chain reaction assay of the cerebrospinal fluid were positive for HSV-1. His course was complicated by 2 episodes of cerebral hemorrhage. He ultimately improved after surgical decompression, treatment with acyclovir, and a switch from a protease inhibitor-based antiretroviral regimen to one including an integrase inhibitor.