HIV Encephalitis

Authors

  • Fitriyani Fitriyani
  • Anisa Zulfiya Rahmah Fakultas Kedokteran, Universitas Lampung

DOI:

https://doi.org/10.53089/medula.v13i5.787

Keywords:

Encephalitis, HIV AIDS, Hydrocephalus

Abstract

HIV encephalitis, also referred to as HIV-associated neurological disorder (HAND), includes a range of neurocognitive defects of varying severity following HIV infection. The clinical presentation of this condition varies from asymptomatic or minor neurocognitive impairment to severe dementia. HIV encephalopathy, also known as AIDS-dementia complex, lies at the most severe end of this spectrum. The diagnosis is based on a combination of clinical neuropsychiatric evaluation and radiological studies. Prompt and effective administration of antiretroviral therapy (ART) is the most effective therapy in managing HIV encephalitis. It has been reported that a 32-year-old male suffers from HIV AIDS with encephalitis. Patient Treated with hemiparese dextra, History of high fever, seizures, and loss of consciousness. The patient also has a history of pulmonary TB and has been taking OAT for the past 9 months. The patient also admitted that he had previously been infected with HIV but had never taken ARVs. From the physical examination found awareness of compos mentis, oral candidiasis in the mouth, and black spots all over the patient's body. There is no neck stiffness, there is parese N.VII and N.XII dextra and positive Babinsky on both legs. Organizational function and memory are impaired. On investigations, a reactive HIV Rapid test was obtained, anemia, leukocytopenia, lymphocytopenia, hyponatremia, hypokalemia, and the results of a CT scan of the head without contrast found hydrocephalus and a chest X-ray within normal limits. Patients were treated with dexamethasone, ranitidine, vitamin B12, and folic acid and were consulted by specialists in internal medicine and neurosurgery for management according to the field.

Author Biographies

Fitriyani Fitriyani

 

 

Anisa Zulfiya Rahmah, Fakultas Kedokteran, Universitas Lampung

 

 

References

Daliparty VM, Balasubramaya R. HIV Encephalitis. [Updated 2022 Sep20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.

Grant I, Franklin DR, Deutsch R, Woods SP, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Collier AC, Marra CM, Clifford DB, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Smith DM, Heaton RK., CHARTER Group. Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline. Neurology. 2014 Jun 10;82(23):2055-62. [PMC free article] [PubMed]

Wendelken LA, Jahanshad N, Rosen HJ, Busovaca E, Allen I, Coppola G, Adams C, Rankin KP, Milanini B, Clifford K, Wojta K, Nir TM, Gutman BA, Thompson PM, Valcour V. ApoE ε4 Is Associated With Cognition, Brain Integrity, and Atrophy in HIV Over Age 60. J Acquir Immune Defic Syndr. 2016 Dec 01;73(4):426-432. [PMC free article] [PubMed]

Levine AJ, Service S, Miller EN, Reynolds SM, Singer EJ, Shapshak P, Martin EM, Sacktor N, Becker JT, Jacobson LP, Thompson P, Freimer N. Genome-wide association study of neurocognitive impairment and dementia in HIV-infected adults. Am J Med Genet B Neuropsychiatr Genet. 2012 Sep;159B(6):669-83. [PMC free article] [PubMed]

Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008 Jul 26;372(9635):293-9. [PMC free article] [PubMed]

Heaton RK, Franklin DR, Deutsch R, Letendre S, Ellis RJ, Casaletto K, Marquine MJ, Woods SP, Vaida F, Atkinson JH, Marcotte TD, McCutchan JA, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor N, Morgello S, Simpson DM, Abramson I, Gamst AC, Fennema-Notestine C, Smith DM, Grant I., CHARTER Group. Neurocognitive change in the era of HIV combination antiretroviral therapy: the longitudinal CHARTER study. Clin Infect Dis. 2015 Feb 01;60(3):473-80. [PMC free article] [PubMed]

Sheppard DP, Iudicello JE, Bondi MW, Doyle KL, Morgan EE, Massman PJ, Gilbert PE, Woods SP. Elevated rates of mild cognitive impairment in HIV disease. J Neurovirol. 2015 Oct;21(5):576-84. [PMC free article] [PubMed]

McGuire JL, Gill AJ, Douglas SD, Kolson DL., CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) group. Central and peripheral markers of neurodegeneration and monocyte activation in HIV-associated neurocognitive disorders. J Neurovirol. 2015 Aug;21(4):439-48. [PMC free article] [PubMed]

Guha D, Wagner MCE, Ayyavoo V. Human immunodeficiency virus type 1 (HIV-1)-mediated neuroinflammation dysregulates neurogranin and induces synaptodendritic injury. J Neuroinflammation. 2018 Apr 27;15(1):126. [PMC free article] [PubMed]

Marquine MJ, Umlauf A, Rooney AS, Fazeli PL, Gouaux BD, Paul Woods S, Letendre SL, Ellis RJ, Grant I, Moore DJ., HIV Neurobehavioral Research Program (HNRP) Group. The veterans aging cohort study index is associated with concurrent risk for neurocognitive impairment. J Acquir Immune Defic Syndr. 2014 Feb 01;65(2):190-7. [PMC free article] [PubMed]

Langford TD, Letendre SL, Larrea GJ, Masliah E. Changing patterns in the neuropathogenesis of HIV during the HAART era. Brain Pathol. 2003 Apr;13(2):195-210. [PMC free article] [PubMed]

Wang T, Gong N, Liu J, Kadiu I, Kraft-Terry SD, Schlautman JD, Ciborowski P, Volsky DJ, Gendelman HE. HIV-1-infected astrocytes and the microglial proteome. J Neuroimmune Pharmacol. 2008 Sep;3(3):173-86. [PMC free article] [PubMed]

Nir TM, Jahanshad N, Busovaca E, Wendelken L, Nicolas K, Thompson PM, Valcour VG. Mapping white matter integrity in elderly people with HIV. Hum Brain Mapp. 2014 Mar;35(3):975-92. [PMC free article] [PubMed]

Valcour V, Paul R, Chiao S, Wendelken LA, Miller B. Screening for cognitive impairment in human immunodeficiency virus. Clin Infect Dis. 2011 Oct;53(8):836-42. [PMC free article] [PubMed]

Chan P, Hellmuth J, Spudich S, Valcour V. Cognitive Impairment and Persistent CNS Injury in Treated HIV. Curr HIV/AIDS Rep. 2016 Aug;13(4):209-17. [PMC free article] [PubMed]

Sacktor N, Skolasky RL, Seaberg E, Munro C, Becker JT, Martin E, Ragin A, Levine A, Miller E. Prevalence of HIV-associated neurocognitive disorders in the Multicenter AIDS Cohort Study. Neurology. 2016 Jan 26;86(4):334-40. [PMC free article] [PubMed]

Simioni S, Cavassini M, Annoni JM, Rimbault Abraham A, Bourquin I, Schiffer V, Calmy A, Chave JP, Giacobini E, Hirschel B, Du Pasquier RA. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010 Jun 01;24(9):1243-50. [PubMed]

Ellis RJ, Letendre S, Vaida F, Haubrich R, Heaton RK, Sacktor N, Clifford DB, Best BM, May S, Umlauf A, Cherner M, Sanders C, Ballard C, Simpson DM, Jay C, McCutchan JA. Randomized trial of central nervous system-targeted antiretrovirals for HIV-associated neurocognitive disorder. Clin Infect Dis. 2014 Apr;58(7):1015-22. [PMC free article] [PubMed]

Decloedt EH, Freeman C, Howells F, Casson-Crook M, Lesosky M, Koutsilieri E, Lovestone S, Maartens G, Joska JA. Moderate to severe HIV-associated neurocognitive impairment: A randomized placebo-controlled trial of lithium. Medicine (Baltimore). 2016 Nov;95(46):e5401. [PMC free article] [PubMed]

Schifitto G, Navia BA, Yiannoutsos CT, Marra CM, Chang L, Ernst T, Jarvik JG, Miller EN, Singer EJ, Ellis RJ, Kolson DL, Simpson D, Nath A, Berger J, Shriver SL, Millar LL, Colquhoun D, Lenkinski R, Gonzalez RG, Lipton SA., Adult AIDS Clinical Trial Group (ACTG) 301. 700 Teams. HIV MRS Consortium. Memantine and HIV-associated cognitive impairment: a neuropsychological and proton magnetic resonance spectroscopy study. AIDS. 2007 Sep 12;21(14):1877-86. [PubMed]

Tunkel AR, Glaser CA, Bloch KC, Sevjar JJ, Marra CM, Roos KL, dkk. The Management of Encephalitis: clinical practice guidelines by the infectious disease society of America. Clin Infect Dis. 2008;47:303-27.

Clifford DB. Neurologic Disease Associated with HIV-1 Infection. In: Johnson RT, Griffin JW, McArthur JC, editors. Current Therapy in Neurologic Disease. 6th ed. St. Louis: Mosby;2002. P. 130-4

Gilroy J. Basic Neurology. 3rd ed. New York: McGraw-Hill; 2000.

Marra CM. infections of The Central Nervous System. In: Samuels MA, editor. Manual of Neurologic Therapeutics 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2004. P.521-41.

Sacktor N. The epidemiology of human immunodeficiency virus-associated neurological disease in the era of highly active antiretroviral therapy. J Neuro-Oncol. 2002;8(Suppl 2):115–21.

McArthur JC, Brew BJ, Nath A. Neurological complications of HIV infection. Lancet Neurol. 2005;4(9):543.

Croucher A, Winston A. Neurological complications of HIV. HIV and AIDS. 2013;41(8):450–5.

Price RW. Neurological complications of HIV infection. Lancet. 1996;348(9025):445–52.

Greenberg MS. Hydrocephalus—general aspects. In: Greenberg MS, editor. Handbook of neurosurgery. 8th ed. New York: Thieme; 2016. p. 394–413.

Loan JJM, Mankahla N, Meintjes G, Fieggen AG. Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol. Systematic Reviews (2017) 6:201.

Gundamraj S, Rodrigo H. Te use of adjunctive steroids in central nervous infections. Front Cell Infect Microbiol. 2020; 10: 59,2017.

Yeomans ND, Svedberg LE, Naesdal J. is ranitidine therapy sufficient for healing peptic ulcers associated with non-steroidal anti-inflammatory drug use?. Int J Clin Pract. 2006 Nov; 60(11): 1401-1407.

Adhikari PM, Mukta NC, John TR, Satish BR, Karthik U, Sahana DA. Effect of vitamin B12 and folic acid supplementation on neuropsychiatric symptoms and immune response in HIV-positive patients. J Neurosci Rural Pract. 2016 Jul-Sep; 7(3): 362-367.

Published

2023-06-18

How to Cite

Fitriyani, F., & Rahmah, A. Z. (2023). HIV Encephalitis. Medical Profession Journal of Lampung, 13(5), 778-786. https://doi.org/10.53089/medula.v13i5.787

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