15th International AIDS Conference


Bangkok, Thailand - July 11-16, 2004

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CYTOMEGALOVIRUS (CMV) ENCEPHALITIS IN A PATIENT WITH ADVANCED HIV AFTER INITIATION OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10207)

Tantisiriwat W, Ruangkit C, Reepolmaha S, Lausoontornsiri W, Harinasuta J, Laohathai P
Samitivej Hospital, Bangkok , Thailand

BACKGROUND: Cytomegalovirus (CMV) infection is one of the common opportunistic infections occurring in advanced HIV infection. Immune reconstitution syndromes (IRS) reported in association with CMV infection and the use of HAART include vitreitis, uveitis, colitis and pneumonitis. CMV encephalitis IRS has not been previously reported.

METHOD: Case report.

RESULT: A 33 year-old Thai woman with AIDS diagnosed CMV encephalitis after 3 weeks of highly active antiretroviral therapy (HAART). The patient had AIDS with CD4+ cell count of 10 cells/mm3 and HIV viral load of 489,000 copies/mL. She presented with CMV retinitis, cryptococcosis and salmonellosis. She was treated with IV antibiotics, amphotericin B followed by fluconazole and intravitreal ganciclovir. After 6 weeks of treating infections, she was started on d4T + 3TC + efavirenz. Three weeks after HAART, she had a behavioral change, visual hallucinations, lower limb weakness and confusion. Brain MRI showed bilateral temporal lobe encephalitis. CSF showed elevated protein, a monocytic pleocytosis and was positive for CMV by PCR and negative for HSV by PCR. She received IV ganciclovir and a short course of steroids with complete resolution of neurological deficit. Three months later, ganciclovir was discontinued while her CD4 cell count was 30 cells/mm3and HIV viral load was undetectable. Follow upMRI (after 12 weeks) showed resolution of encephalitis. After 6 months on HAART she is well with CD4 cell count of 150 cells/mm3 and an undetectable HIV viral load.

CONCLUSION: Encephalitis from CMV was observed 3 weeks after the initiation of HAART in a patient with advanced AIDS and CMV retinitis suggesting an exaggerated pathologic inflammatory response played a role in the pathogenesis of this presentation. Clinicians should be aware of this potential manifestation of CMV IRS and consider systemic therapy of CMV retinitis in persons with advanced HIV infection if HAART is going to be initiated.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Antiretroviral Therapy, Highly Active, Cytomegalovirus, Cytomegalovirus Retinitis, HIV Seropositivity, CD4 Lymphocyte Count, Cytomegalovirus Infections, Ganciclovir, HIV Infections, Encephalitis, Stavudine, Polymerase Chain Reaction, Humans, Female

040711
B10207

Copyright © 2004 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.