Reactions 1406 - 16 Jun 2012

SAtazanavir

Suboptimal CNS levels leading to encephalitis:2 case reports

A 57-year-old man and a 47-year-old man with HIV-1infections were receiving HAART which includedatazanavir, and developed HIV-1 viral encephalitis relatedto suboptimal CNS drug levels.

When they presented with neurological symptoms,patients 1 and 2 had been receiving stable antiretroviraltherapy which included atazanavir for 47 or 20 months,respectively [routes and dosages not stated]. Patient 1 haddeveloped changes in recent memory, apathy, andemotional lability; patient 2 had ataxia, tremor and foodrefusal. Investigations revealed undetectable plasma HIV inboth, but the CSF viral loads were 24 000 copies/mL inpatient 1 and 6850 copies/mL in patient 2. Both werediagnosed with HIV-1 viral encephalitis.

The men’s antiretroviral therapy was switched tolopinavir/ritonavir, abacavir and lamivudine but theirclinical and CSF anomalies persisted. Resistance toatazanavir and intermediate resistance to lopinavir wasidentified in both patients, and their treatments werechanged to abacavir, lamivudine, darunavir, ritonavir, andraltegravir. Both men subsequently recovered.

Author comment: "[A] high baseline HIV RNA level, a lownadir CD4+ count, and suboptimal CSF levels of atazanavirwere considered as the risk factors for developingencephalitis."del Palacio Tamarit M, et al. HIV type 1 viral encephalitis after development ofviral resistance to plasma suppressive antiretroviral therapy. AIDS Research andHuman Retroviruses 28: 83-6, No. 1, 2012 - Spain 803071870

1

Reactions 16 Jun 2012 No. 14060114-9954/10/1406-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved