final program.qxd - Parallels Plesk Panel

PP 3.4
Reversible HIV associated encephalomyelitis successfully treated with HAART
Imbert P, Rapp c, Bladé JS, De Greslan T*, Barruet R , Flocard F*, Debord T
Department of infectious and tropical diseases Military hospital Bégin,94163 Saint-Mandé,
France * Department of Neurology Military Hospital Vâl de Grace,75006 Paris, France
HIV is rarely associated to a demyelinating lesion of the central nervous system. We
report a reversible HIV Associated Encephalomyelitis (HAREM) observation with a
favourable outcome under HAART.
Observation
A 31 year old male is followed-up since 1992 for an asymptomatic HIV-1 infection (CD4 >
500/mm 3 ). In February 2001, he presented with a severe retrobulbar optic neuritis and
neurological impairments which evolved by episodes with an extended demyelination on
the MRI. Rapid intravenous administrations of corticosteroids were ineffective. In June
2002, an AZT-3TC-Efavirenz tritherapy was started, after noticing a viral replication in the
CSF (600 copies/mL). A genotypic study of the resistances was done before the
introduction of the treatment. Despite clinical effectiveness and excellent immunological
and virological responses, the treatment was replaced in January 2003 by the AZT-3TCindinavir-ritonavir
association following an acute episode of anxiety which made him
attack his wife with a knife.The neurological improvement is currently continuing (sport
and work resumption) and the MRI anomalies are progressively regressing.
Comments
In our patient, HIV encephalitis and progressive multifocal leucoencephalopathy (PMLE)
were easily ruled out. Multiple sclerosis or acute disseminated encephalomyelitis (ADEM)
were evoked, but corticosteroids were ineffective. HAREM is a rare demyelinating
affection, associated to an in situ HIV replication that is responsible of inflammatory or
vascular lesions of debatable mechanism. The clinical and radiological improvement
under antiretroviral tritherapy pleads for this latter hypothesis and for an active treatment
on the HIV replication in the encephalic sanctuary.
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