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HIV positive patient with HSV-2 encephalitis: case report
Pasquale Pagliano1, Tiziana Ascione1, Maria Aurora Carleo1
1Department of Infectious Diseases, AORN dei Colli, D. Cotugno Hospital, Naples, Italy.
Le Infezioni in Medicina
|September 27, 2016
Summary
Herpes Simplex Virus type 2 (HSV-2) encephalitis can occur in Human Immunodeficiency Virus (HIV) patients on antiretroviral therapy. Switching to drugs with poor brain penetration may increase risk for such infections.
Area of Science:
- Neurovirology
- Infectious Diseases
- Antiretroviral Therapy Research
Background:
- High active antiretroviral therapy (HAART) has reduced brain infections in Human Immunodeficiency Virus (HIV) patients.
- Herpes Simplex Virus type 2 (HSV-2) is an uncommon cause of encephalitis in HIV patients, despite its prevalence in sexually transmitted infections.
Observation:
- A case of HSV-2 encephalitis is reported in a 38-year-old HIV-positive man experiencing recurrent seizures and fever.
- The patient was on a rilpivirine-based regimen with undetectable HIV-RNA in plasma but had detectable HIV-RNA in cerebrospinal fluid (CSF).
- Clinical presentation included fever, confusion, inability to walk, and brain MRI showing lesions in the medial temporal lobes and hippocampus.
Findings:
- Cerebrospinal fluid (CSF) analysis revealed increased protein and cells with lymphocyte prevalence, along with detectable HSV-2 DNA and HIV-RNA.
- Treatment with acyclovir led to clinical improvement and clearance of HSV-2 DNA from CSF.
- The patient's HAART was switched to a regimen with high CSF penetrability.
Implications:
- Patients on antiretroviral regimens with poor CSF penetration, such as those containing rilpivirine, may be at increased risk for opportunistic brain infections.
- This case highlights the importance of considering CSF drug concentrations and potential opportunistic infections in HIV patients, even on HAART.
- Further research is needed to confirm the association between specific antiretroviral regimens and the risk of brain opportunistic infections in HIV.
