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Published on: October 6, 2016
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Therapy challenges for NMOSD in a patient with HIV
Daniel Engels1, Joachim Havla1, Stefanie Förderreuther2
1Institute of Clinical Neuroimmunology, University Hospital, LMU Munich, Munich, Germany.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|September 15, 2023
Summary
Neuromyelitis optica spectrum disorder (NMOSD) in people living with HIV (PLWH) is rare. This case highlights challenges in managing NMOSD with immunotherapy, particularly regarding SARS-CoV-2 vaccination response.
Area of Science:
- Neuroimmunology
- Infectious Diseases
Background:
- Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune condition affecting the central nervous system.
- Co-occurrence of NMOSD and HIV presents unique management challenges, particularly concerning immune reconstitution and treatment efficacy.
Observation:
- A case of AQP4-IgG-positive NMOSD in a person living with HIV (PLWH) during the COVID-19 pandemic is presented.
- Initial treatment with corticosteroids, plasma exchange, and rituximab stabilized NMOSD and HIV.
- Insufficient SARS-CoV-2 immune response was noted after vaccinations despite immunotherapy.
Findings:
- Switching immunotherapy from rituximab to satralizumab led to peripheral B cell recovery and restored humoral immune response to SARS-CoV-2 vaccination.
- This suggests a complex interplay between NMOSD immunotherapies, B cell populations, and vaccine responsiveness in PLWH.
Implications:
- This case underscores the difficulties in managing NMOSD in PLWH, especially concerning vaccine immunogenicity.
- Optimizing immunotherapy strategies is crucial for both NMOSD control and adequate immune protection against infections like SARS-CoV-2 in this vulnerable population.
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