Successful Utilization of Levodopa in HIV-Induced Parkinsonism

We report a case of a 63-year-old African American female patient with a past medical history of treatment naïve human immunodeficiency virus (HIV). She was referred to our hospital with altered mental status and rigidity with a history of progressive ambulation difficulties and decreased verbal output over the previous months as reported by her son. Her clinical presentation and brain MRI were consistent with HIV encephalopathy with bilateral basal ganglia involvement and HIV-induced parkinsonism. We initiated a trial of carbidopa/levodopa along with highly active antiretroviral therapy (HAART) (emtricitabine-tenofovir and dolutegravir). In the following three weeks, she demonstrated dramatic improvement, both clinically and radiologically. She tolerated carbidopa/levodopa well with no behavioral or neurological side effects. This case illustrates the safe utilization of carbidopa/levodopa in treating parkinsonism in an adult female patient with HIV encephalopathy.