Adaptation of antiretroviral therapy in human immunodeficiency virus infection with central nervous system involvement

J Neurovirol. 2008 Jan;14(1):78-84. doi: 10.1080/13550280701793940.

Abstract

The authors describe a patient with known human immunodeficiency virus (HIV)-1 infection who presented with two generalized seizures and was found to have extensive white matter disease and a left/bilateral temporo-occipital focal slowing on electroencephalography (EEG). There were no magnetic resonance imaging (MRI) or cerebrospinal fluid (CSF) indications for opportunistic infection. Plasma viremia was controlled, whereas viral replication was uncontrolled in CSF. CSF-specific genotype-guided adaptation of the antiretroviral therapy in order to optimize central nervous system (CNS) penetration resulted in clinical improvement and normalization of MRI and EEG. Our case report illustrates the importance of individualized antiretroviral therapy in HIV infected patients with neurological complications.

Publication types

  • Case Reports

MeSH terms

  • AIDS Dementia Complex / cerebrospinal fluid
  • AIDS Dementia Complex / drug therapy*
  • AIDS Dementia Complex / pathology
  • AIDS Dementia Complex / virology
  • Adenine / administration & dosage
  • Adenine / analogs & derivatives
  • Adenine / pharmacokinetics
  • Adenine / therapeutic use
  • Adult
  • Alkynes
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / pharmacokinetics
  • Anti-HIV Agents / therapeutic use*
  • Anticonvulsants / classification
  • Anticonvulsants / therapeutic use
  • Antiretroviral Therapy, Highly Active / methods*
  • Atazanavir Sulfate
  • Benzoxazines / administration & dosage
  • Benzoxazines / pharmacokinetics
  • Benzoxazines / therapeutic use
  • Cerebrospinal Fluid / virology
  • Cyclopropanes
  • Didanosine / administration & dosage
  • Didanosine / pharmacokinetics
  • Didanosine / therapeutic use
  • HIV-1 / genetics
  • HIV-1 / isolation & purification
  • HIV-1 / physiology*
  • Humans
  • Indinavir / administration & dosage
  • Indinavir / pharmacokinetics
  • Indinavir / therapeutic use
  • Lamivudine / administration & dosage
  • Lamivudine / pharmacokinetics
  • Lamivudine / therapeutic use
  • Male
  • Nelfinavir / administration & dosage
  • Nelfinavir / pharmacokinetics
  • Nelfinavir / therapeutic use
  • Nevirapine / administration & dosage
  • Nevirapine / pharmacokinetics
  • Nevirapine / therapeutic use
  • Oligopeptides / administration & dosage
  • Oligopeptides / pharmacokinetics
  • Oligopeptides / therapeutic use
  • Organophosphonates / administration & dosage
  • Organophosphonates / pharmacokinetics
  • Organophosphonates / therapeutic use
  • Pyridines / administration & dosage
  • Pyridines / pharmacokinetics
  • Pyridines / therapeutic use
  • Ritonavir / administration & dosage
  • Ritonavir / pharmacokinetics
  • Ritonavir / therapeutic use
  • Seizures / drug therapy
  • Seizures / etiology
  • Stavudine / administration & dosage
  • Stavudine / pharmacokinetics
  • Stavudine / therapeutic use
  • Tenofovir
  • Viral Load
  • Virus Replication
  • Zidovudine / administration & dosage
  • Zidovudine / pharmacokinetics
  • Zidovudine / therapeutic use

Substances

  • Alkynes
  • Anti-HIV Agents
  • Anticonvulsants
  • Benzoxazines
  • Cyclopropanes
  • Oligopeptides
  • Organophosphonates
  • Pyridines
  • Lamivudine
  • Zidovudine
  • Atazanavir Sulfate
  • Indinavir
  • Nevirapine
  • Tenofovir
  • Stavudine
  • Nelfinavir
  • Adenine
  • efavirenz
  • Didanosine
  • Ritonavir