Therapeutic failure and central nervous system involvement in a patient living with HIV/AIDS

Abstract

Introduction: Acquired immunodeficiency syndrome (AIDS) is the ultimate stage of human immunodeficiency virus (HIV) infection. During this stage, the patient is susceptible to severe complications and co-infections due to a compromised immune system. If viral ribonucleic acid replication cannot be maintained below 1000 copies/mL 24 weeks after initiation of antiretroviral therapy, the patient is considered to have virological failure.

Objective: To highlight the importance of viral genotyping and frequent monitoring of HIV viral load to delay early progression to virological failure.

Case report: 34-year-old woman with virological failure after 12 months of antiretroviral therapy for AIDS. She was brought to the emergency service for insidious and progressive left hemiplegia associated with ring-enhancing and cystic lesions in the brain suggestive of toxoplasmosis, as well as other recurrent neurological manifestations, after a previous admission for focal motor signs and disorientation a year earlier. Viral genotyping test showed resistance to ten different anti-HIV drugs, including first-line drugs. Two months after medical discharge, there was clear clinical and neurological improvement, coherent speech, independent walking, and low lymphocyte count; however, the viral load increased.

Conclusion: Virological failure in patients with AIDS may be the result of multiple factors, but the most worrisome is resistance to anti-HIV drugs. Therapeutic failure decreases the quality of life, increases the risk of recurrent diseases, and the susceptibility to opportunistic infections.