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Human herpesvirus 6‐associated retrobulbar optic neuritis in an HIV‐infected patient: response to anti‐herpesvirus therapy and long‐term outcome
Author(s) -
Méchaï Frédéric,
Boutolleau David,
Manceron Véronique,
Gasnault Jacques,
Quertainmont Yann,
Brosseau JeanPaul,
Delfraissy JeanFrançois,
Labetoulle Marc,
Goujard Cécile
Publication year - 2007
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.20833
Subject(s) - cidofovir , foscarnet , medicine , ganciclovir , optic neuritis , human herpesvirus 6 , viral load , virology , gastroenterology , immunology , human immunodeficiency virus (hiv) , virus , viral disease , herpesviridae , human cytomegalovirus , multiple sclerosis
Like other herpesviruses, human herpesvirus 6 (HHV‐6) can reactivate in immunocompromised patients. A case is described of an HIV‐1‐infected patient who developed bilateral retrobulbar optic neuritis associated with HHV‐6 infection. A 59‐year‐old woman, infected with HIV for 18 years, interrupted antiretroviral treatment because of therapeutic failure and severe metabolic complications. She presented subsequently with blurred vision and ophthalmological examination showed visual loss due to optic neuritis. Her CD4+ count was 285 cells/mm 3 and her plasma HIV‐1 RNA level was 5.5 log 10 copies (cp)/ml. Magnetic resonance imaging of the brain was normal. HHV‐6 loads were 3.2 log cp/ml in cerebrospinal fluid (CSF) and 6.3 log cp/10 6 peripheral blood mononuclear cells. Combined intravenous treatment was started with foscarnet and ganciclovir then changed to cidofovir and long‐term valganciclovir. Her ocular condition improved gradually despite little decrease of the HHV‐6 load in the CSF. Salvage antiretroviral treatment was then administered, with marked immunological and virological responses, contributing to further progressive ocular improvement. HHV‐6‐related optic neuritis has not been described previously in HIV‐infected patients. Anti‐HHV‐6 treatment improved the patient's vision, but immune restoration seems to remain essential for long‐term recovery. J. Med. Virol. 79:931–934, 2007. © 2007 Wiley‐Liss, Inc.