Table 1.
Twenty-three adults in UK with pathologically-confirmed HIV-associated CD8 encephalitis (HIV-CD8E).
| Case | Age/sex | Previous (months) | Current | ART | CPE score | Risk event category | Clinical presentation | Imaging | CSF | Cortico-steroids | Outcome | Diagnosis mode | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CD4 c/μL | pVL c/mL | CD4 c/μL | CD8 c/μL | pVL c/mL | Cells | Protein g/L | VL c/mL | ||||||||||
| 1a | 32/F | 122 (3) | 1,193 (3) | 95 | ND | 291 | Stopped Z, Em, s/L 3 m previously | 8 | 4 | 17 d headache, confusion | Typical | 12 ly | 0.4 | ND | No | Died of HIV-CD8E | Autopsy |
| 2 | 40/M | 547 (4) | 19,126 | 543 | NA | 21,359 | Nil | 0 | 6 | 28 d headache, confusion, | Typical | 17 ly | 1.35 | ND | Yes | Died of HIV-CD8E | Autopsy |
| 3 | 28/F | 847 (3) | <50 (3) | 876 | 2,001 | <50 | D, Z, r/L | 9 | 1 | 7 d headache, confusion | Typical | 20 ly | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 4 | 46/F | 360 (4) | 2,600 (4) | 170 | 960 | 86,800 | stopped A, T, r/S 4 m previously | 5 | 3 | Cardiac arrest | ND | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 5 | 40/M | NA | NA | 315 | 306 | <50 | F, r/S | 3 | 2 | 10 d confusion | Typical | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 6 | 36/M | 847 (3) | <50 (3) | >400 | NA | 3,568 | D, Z, r/L | 9 | 3 | 7 d headache, confusion, fits | Typical | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 7 | 43/F | 410 (4) | <50 (4) | 240 | 1,290 | <50 | T, D, r/A | 5 | 1 | 21 d headache, TIA | Typical | 8 ly | 0.68 | ND | No | Died of HIV-CD8E | Autopsy |
| 8 | 47/F | 1,030 (5) | <50 (5) | 824 | 1,755 | 238 | r/A | 2 | 3 | 7 d headache, confusion | Typical | NA | >0.8 | ND | No | Died of HIV-CD8E | Autopsy |
| 9b | 49/F | 521 (4) | 28,808 (4) | 374 | 970 | 12,062 | T, A, r/A | 6 | 4 | 28 d cognitive impairment | Typical | ND | ND | ND | No | Survived | Brain biopsy |
| 10 | 29/F | 530 (3) | NA | 560 | 960 | <50 | L, A, r/L | 7 | 1 | 5 d headache, obtunded | Typical | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 11 | 41/F | NA | 151,544 (3) | 266 | NA | 439 | A, M, R, r/L | 12 | 3 | 4 d headache, cardiac arrest | ND | ND | ND | ND | No | Died of PE following recovery | Autopsy |
| 12 | 44/M | 298 (3) | <50 (3) | 233 | 896 | <50 | E, r/D | 5 | 1 | 28 d headache, 17 d confused | Typical | 80 ly | 1.2 | <50 | Yes | Died of HIV-CD8E | Autopsy |
| 13 | 37/F | 1,032 (5) | <50 (5) | 353 | 880 | 8,759 | stopped T, Em, r/S 1 m previously | 5 | 2 + 3 | 28 d headache, 6 d vomiting | Typical | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 14 | 19/M | 10 (4) | NA | 64 | NA | 600 | T, Em, Ef | 7 | 4 | 21 d limb paraesthesia 7 d seizures | Typical | ND | ND | ND | Yes | Survived | Brain biopsy |
| 15 | 33/F | 370 (3) | 340 (7) | 200 | 1,340 | 8,300 | Nil | 0 | 6 | Found dead (at home) | ND | ND | ND | ND | No | Died of HIV-CD8E and DILS | Autopsy |
| 16 | 51/F | 1,024 (5) | <50 (5) | ND | ND | ND | T, Em, r/D | 7 | 2 | 4 d headache, vomiting | Typical | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 17cz | 52/F | 870 (3) | <50 (3) | 220 | 360 | <50 | T, Em, r/A | 6 | 2 | 21 d headache, confusion, drowsy | Typical | ND | ND | 1,100 = VE | Yes | Survived | Brain biopsy |
| 18 | 33/F | 450 (11) | <50 (11) | 348 | 741 | 3,300 | M, r/D | 9 | 3 | 28 d headache, cardiac arrest; second trimester pregnancy | Typical | NA | NA | 7,700 = VE | No | Died of HIV-CD8E | Autopsy |
| 19 | 35/F | 594 (3) | 91,201 (3) | 487 | 703 | 125,893 | stopped r/D 5 m previously | 3 | 3 | 14 d headache, confusion | Typical | ND | ND | ND | Yes | Survived | Brain biopsy |
| 20 | 52/F | 1,283 (8) | 460 (2) | ND | ND | ND | T, Em, c/D | 7 | 1 | 10 d headache, vomiting, ataxia, coned | Typical | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 21a | 45/M | 50 (2.5) | 838,000 (2.5) | 320 | ND | 4,000 | E, L, Z | 8 | 4V | 7 d worsening of long-standing cognitive decline: 2 d generalized seizures | Typical | 23 ly | 1.15 | ND | No | Died of HIVE and HIV-CD8E | Autopsy |
| 22 | 45/M | 520 (12) | <50 (7) | ND | ND | ND | L, M, r/A | 7 | 2 | 3 d worsening of long-standing cognitive decline | ND | ND | ND | ND | No | Died of HIV-CD8E | Autopsy |
| 23 | 69/M | 400 (13) | <50 (13) | 460 | NA | <50 | T, Em, N | 8 | 1V | 10 d headache, confusion 2 d seizures | Typical | 26 | 0.56 | <50 | Yes | Died of HIV-CD8E | Autopsy |
Previously published references:
(1);
(13);
(11). Key: d, days; m, months; c/μL, cells/μL; pVL, plasma viral load (c/mL: copies/mL); VL, viral load (c/mL: copies/mL); ND, not done; NA, not available; ART, antiretroviral therapy; A, abacavir; c/D, cobicistat-boosted darunavir; D, didanosine; E, etravirine; Ef, efavirenz; Em, emtricitabine; F, fosamprenavir; L, lamivudine; M, maraviroc; N, nevirapine; r/A, ritonavir-boosted atazanavir; r/D, ritonavir-boosted darunavir; r/L, ritonavir-boosted lopinavir; r/S, ritonavir-boosted saquinavir; R, raltegravir; T, tenofovir; Z, zidovudine; PE, pulmonary thromboembolism; TIA, transient ischaemic attack; HIV-CD8E, HIV-CD8 encephalitis; VE, CSF viral escape; ly, lymphocytes; HIVE, HIV encephalitis; DILS, diffuse infiltrative lymphocytosis syndrome. Risk event: 1, well-controlled HIV infection, occurring without identified risk event; 2, intercurrent infection or malignancy; 3, ART treatment interruption/poor adherence; 4, IRIS after commencing ART; 5, ART drug resistance; 6, not in receipt of ART; V, variant.