HIV-Associated Neurocognitive Disorder and CNS Viral Escape: A Case Report

TL;DR

This case report describes a patient with HIV who developed brain-related cognitive issues and showed virus activity in the brain despite treatment, highlighting the need for tailored therapies.

Contribution

The case emphasizes the importance of CNS-specific HIV replication and tailored ART regimens in managing HAND with CNS viral escape.

Findings

A patient with HIV showed cognitive impairment and CNS viral escape despite ART.

Switching to a different ART regimen led to significant clinical improvement.

Comprehensive diagnostics are essential for accurate HAND diagnosis and treatment.

Abstract

HIV-associated neurocognitive disorder (HAND) encompasses a spectrum of cognitive impairments prevalent in individuals infected with HIV, despite effective combination antiretroviral therapy. This case report discusses a 42-year-old male with a history of HIV infection since 2014 who is currently on antiretroviral therapy (ART). The patient presented with cognitive impairment and generalized weakness, with subsequent investigations revealing HAND and CNS viral escape. The patient’s management involved a switch to a different ART regimen, resulting in significant clinical improvement. This case highlights the importance of considering CNS-specific HIV replication in patients with neurocognitive symptoms and underscores the need for tailored ART regimens. The exclusion of progressive multifocal leukoencephalopathy through negative JC virus PCR was crucial in directing appropriate management. Comprehensive diagnostic evaluations, including CSF analysis and brain imaging, are essential for the accurate diagnosis and effective treatment of HAND, particularly in cases of CNS viral escape.

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