Neurosymptomatic HIV CSF viral escape with parkinsonism and amyotrophic lateral sclerosis-like syndrome: a case report.
Francesca Bridge, Wesley Thevathasan, David Schultz et al.
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Case in brief
A 42-year-old man with chronic HIV and a history of Parkinson's disease presented with neurologic symptoms including hyperreflexia, limb weakness, and gait instability. Despite adherence to combined anti-retroviral therapy (CART), he exhibited CSF viral escape with a CSF viral load of 35 copies/mL while plasma levels remained suppressed. The diagnosis was HIV-associated neurological overlap syndrome, prompting an adjustment in his CART regimen to enhance CNS penetration.
What made this case unusual
The case highlights the occurrence of neurosymptomatic HIV CSF viral escape in a patient with well-controlled plasma viral load, presenting with parkinsonism and amyotrophic lateral sclerosis-like symptoms.
Diagnostic / clinical pearl
Clinicians should consider testing CSF viral load in HIV patients with new neurologic symptoms, even when plasma viral load is suppressed.
Why it matters
This case underscores the need for awareness of CSF viral escape as a potential complication in HIV patients on CART, which may necessitate adjustments in treatment to improve CNS outcomes.