CD8 Encephalitis Caused by Persistently Detectable Drug-resistant HIV

Area of Science:

• Neuroscience
• Immunology
• Infectious Diseases

Background:

• Antiretroviral therapy (ART) is standard for HIV management.
• Long-term HIV infection can lead to neurological complications.
• Drug resistance mutations, like M184V, can impact treatment efficacy.

Observation:

• A 52-year-old male with a 17-year history of HIV presented with severe neurocognitive disorders and bilateral leukoencephalopathy.
• Despite ART, persistent low-level viremia and M184V mutation in serum and CSF were noted.
• Brain biopsy confirmed CD8 encephalitis characterized by perivascular CD8(+) T-lymphocyte infiltration.

Findings:

• The M184V mutation is associated with resistance to certain antiretroviral drugs.
• CD8 encephalitis is a rare but serious neurological complication of HIV.
• A switch to a nucleoside reverse transcriptase inhibitor-sparing regimen was effective.

Implications:

• This case highlights the importance of monitoring for neurological complications in long-term HIV patients.
• Tailoring ART regimens based on resistance testing and clinical presentation is crucial.
• Successful management of CD8 encephalitis can be achieved through strategic treatment adjustments.