CD8 Encephalitis in HIV-Infected Patients Receiving cART: A Treatable Entity

• Published in: Clinical infectious diseases 2013-07, Vol.57 (1), p.101-108
• Main Authors: Lescure, François-Xavier, Moulignier, Antoine, Savatovsky, Julien, Amiel, Corinne, Carcelain, Guislaine, Molina, Jean-Michel, Gallien, Sébastien, Pacanovski, Jérôme, Pialoux, Gilles, Adle-Biassette, Homa, Gray, Françoise
• Format: Article
• Language: English
• Subjects: Adult; AIDS; Anti-Inflammatory Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Biological and medical sciences; Biopsies; Biopsy; Brain; Brain - diagnostic imaging; Brain - pathology; CD8-Positive T-Lymphocytes - immunology; Cerebrospinal Fluid - cytology; Cerebrospinal Fluid - virology; Encephalitis; Encephalitis - drug therapy; Encephalitis - immunology; Encephalitis - pathology; Female; Glucocorticoids - therapeutic use; Highly active antiretroviral therapy; HIV; HIV - isolation & purification; HIV Infections - complications; HIV Infections - drug therapy; HIV/AIDS; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infections; Infectious diseases; Lentivirus; Lesions; Lymphocytes; Lymphocytosis; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system; NMR; Nuclear magnetic resonance; Pathology; Radiography; Retrospective Studies; Retroviridae; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral infections; Viral Load
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cit175

Background. Despite its overall efficacy, combined antiretroviral therapy (cART) has failed to control human immunodeficiency virus (HIV) infection of the central nervous system (CNS). New acute and chronic neurological complications continue to be reported. Methods. We conducted a retrospective study of 14 HIV-infected patients with documented encephalitis, which was initially attributed to an undetermined origin. Brain magnetic resonance imaging (MRI) uniformly revealed unusual, multiple linear gadolinium-enhanced perivascular lesions. Results. All patients had manifested acute or subacute neurological symptoms; the brain MRIs indicating diffuse brain damage. The mean duration of HIV infection was approximately 10 years, and 8 patients were immunovirologically stable. Cerebrospinal fluid abnormalities with mildly elevated protein and pleocytosis with >90% lymphocytes, predominantly CD8, were found in all but 1 patient. The mean cerebral spinal fluid HIV load was 5949 copies/mL. Six patients reported a minor infection a few days prior to neurological symptoms, 2 patients presented criteria for the immune reconstitution inflammatory syndrome of the CNS, 2 were in virological escape, and 1 developed encephalitis after interruption of cART. Brain biopsies revealed inflammatory encephalitis associated with astrocytic and microglial activation as well as massive perivascular infiltration by polyclonal CD8 + lymphocytes. All patients had been treated with glucocorticosteroids. The long-term therapeutic response varied from excellent, with no sequalae (n = 5), to moderate, with cognitive disorders (n = 4). The mean survival time was 8 years; however, 5 patients died within 13 months of initiation of treatment. Conclusions. CD8 encephalitis in HIV-infected patients receiving cART is a clinical entity that should be added to the list of HIV complications.