Human Pegivirus Encephalitis With Brain Detection and Response to Sofosbuvir Ledipasvir

Area of Science:

• Neurology
• Virology
• Immunocompromised Host Research

Background:

• Human pegivirus (HPgV-1) is increasingly recognized but its role in central nervous system (CNS) disease is not well-defined.
• Previous associations of HPgV-1 include severe encephalomyelitis, primarily in immunocompromised patients.
• The neurological spectrum and pathogenic mechanisms of HPgV-1 require further elucidation.

Purpose of the Study:

• To describe a case of slowly progressive encephalitis associated with HPgV-1 infection in an individual with well-controlled HIV.
• To investigate the presence and role of HPgV-1 in CNS disease.
• To evaluate the efficacy of antiviral therapy in HPgV-1-associated neurological conditions.

Main Methods:

• Case report of a patient with HIV presenting with neurological symptoms.
• Cerebrospinal fluid (CSF) and brain tissue analysis using metagenomic sequencing for pathogen detection.
• Clinical and laboratory monitoring before and after off-label antiviral treatment.

Main Results:

• A patient with well-controlled HIV developed a slowly progressive encephalitis with white matter abnormalities and CSF inflammation.
• Metagenomic sequencing detected HPgV RNA in CSF and brain tissue, with no other pathogens identified.
• Off-label treatment with sofosbuvir/ledipasvir led to sustained clinical improvement, CSF normalization, and undetectable HPgV RNA.

Conclusions:

• This case expands the known clinical spectrum of HPgV-1 to include encephalitis in individuals with well-controlled HIV.
• The findings support a potential etiological role for HPgV-1 in certain CNS inflammatory conditions.
• Further research is warranted to understand HPgV-1's neurotropic potential and the effectiveness of antiviral therapies.