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Giuseppe Vittorio L. DeSocio, Laura Martinelli, Maurizio Zazzi, Franco Baldelli, Acute Meningoencephalitis in Chronic HIV Infection: Clinical Resolution with Lopinavir-Ritonavir–Containing Therapy, Clinical Infectious Diseases, Volume 46, Issue 12, 15 June 2008, Page 1938, https://doi.org/10.1086/588554
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To the Editor—We read with interest the article by Letendre et al. [1], which showed that lopinavir-ritonavir therapy reduced autonomous human immunodeficiency virus (HIV) RNA levels in CSF. We recently observed a case of symptomatic acute neurological syndrome in a patient with chronic HIV infection and exceedingly high CSF HIV levels; the neurological syndrome was successfully treated with antiretroviral therapy containing lopinavir-ritonavir.
To our knowledge, acute meningoencephalitis secondary to HIV infection has been described in 3 patients with chronic HIV infection [2], but neither high levels of HIV in CSF nor successful treatment with lopinavir-ritonavir was reported in any of these cases.
A 35-year-old African man was admitted to the hospital (“Santa Maria della Misericordia” Hospital; Perugia, Italy) with a 4-week history of severe headache, apathy, and impairment in cognitive function. At hospital admission, the patient presented with severe confusion, complete disorientation, neck stiffness, severe weakness of the limbs, urinary retention, molluscum contagiosum in the face, and oral thrush. Serological diagnosis of HIV infection was made by ELISA, followed by a fully reactive confirmatory recombinant immunoblot test for antibody to HIV. The patient's CD4+ T lymphocyte count was 35 cells/µL, and his plasma HIV RNA level was 159,000 copies/mL. An MRI of the brain showed increased T2-weighted signal diffusely scattered with confluent aspect. An electroencephalographic examination revealed diffuse abnormal findings.
