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HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases

HIV-associated CD8-encephalitis (HIV-CD8E) is a severe inflammatory disorder dominated by infiltration of the brain by CD8(+) T-lymphocytes. It occurs in people with HIV, typically when the virus is apparently well-controlled by antiretroviral treatment (ART). HIV-CD8E presents with symptoms and sig...

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Main Authors: Lucas, Sebastian B., Wong, Kum T., Nightingale, Sam, Miller, Robert F., Encephalitis, HIV Associated CD8
Format: Article
Published: Frontiers Media 2021
Subjects:
R Medicine (General)
Online Access:http://eprints.um.edu.my/26478/
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spelling my.um.eprints.264782022-03-07T08:07:03Z http://eprints.um.edu.my/26478/ HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases Lucas, Sebastian B. Wong, Kum T. Nightingale, Sam Miller, Robert F. Encephalitis, HIV Associated CD8 R Medicine (General) HIV-associated CD8-encephalitis (HIV-CD8E) is a severe inflammatory disorder dominated by infiltration of the brain by CD8(+) T-lymphocytes. It occurs in people with HIV, typically when the virus is apparently well-controlled by antiretroviral treatment (ART). HIV-CD8E presents with symptoms and signs related to marked cerebral inflammation and swelling, and can lead to coma and death unless treated promptly with corticosteroids. Risk events such as intercurrent infection, antiretroviral therapy interruption, immune reconstitution inflammatory syndrome (IRIS) after starting ART, and concomitant associations such as cerebrospinal fluid (CSF) HIV viral escape have been identified, but the pathogenesis of the disorder is not known. We present the largest case series of HIV-CD8E to date (n = 23), representing histopathologically confirmed cases in the UK. We also summarize the global literature representing all previously published cases with histopathological confirmation (n = 30). A new variant of HIV-CD8E is described, occurring on a background of HIV encephalitis (HIVE).Together these series, totalling 53 patients, provide new insights. CSF HIV viral escape was a frequent finding in HIV-CD8E occurring in 68% of those with CSF available and tested; ART interruption and IRIS were important, both occurring in 27%. Black ethnicity appeared to be a key risk factor; all but two UK cases were African, as were the majority of the previously published cases in which ethnicity was stated. We discuss potential pathogenic mechanisms, but there is no unifying explanation over all the HIV-CD8E scenarios. Frontiers Media 2021-04-01 Article PeerReviewed Lucas, Sebastian B. and Wong, Kum T. and Nightingale, Sam and Miller, Robert F. and Encephalitis, HIV Associated CD8 (2021) HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases. Frontiers in Neurology, 12. ISSN 1664-2295, DOI https://doi.org/10.3389/fneur.2021.628296 <https://doi.org/10.3389/fneur.2021.628296>. 10.3389/fneur.2021.628296
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine (General)
spellingShingle R Medicine (General)
Lucas, Sebastian B.
Wong, Kum T.
Nightingale, Sam
Miller, Robert F.
Encephalitis, HIV Associated CD8
HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases
description HIV-associated CD8-encephalitis (HIV-CD8E) is a severe inflammatory disorder dominated by infiltration of the brain by CD8(+) T-lymphocytes. It occurs in people with HIV, typically when the virus is apparently well-controlled by antiretroviral treatment (ART). HIV-CD8E presents with symptoms and signs related to marked cerebral inflammation and swelling, and can lead to coma and death unless treated promptly with corticosteroids. Risk events such as intercurrent infection, antiretroviral therapy interruption, immune reconstitution inflammatory syndrome (IRIS) after starting ART, and concomitant associations such as cerebrospinal fluid (CSF) HIV viral escape have been identified, but the pathogenesis of the disorder is not known. We present the largest case series of HIV-CD8E to date (n = 23), representing histopathologically confirmed cases in the UK. We also summarize the global literature representing all previously published cases with histopathological confirmation (n = 30). A new variant of HIV-CD8E is described, occurring on a background of HIV encephalitis (HIVE).Together these series, totalling 53 patients, provide new insights. CSF HIV viral escape was a frequent finding in HIV-CD8E occurring in 68% of those with CSF available and tested; ART interruption and IRIS were important, both occurring in 27%. Black ethnicity appeared to be a key risk factor; all but two UK cases were African, as were the majority of the previously published cases in which ethnicity was stated. We discuss potential pathogenic mechanisms, but there is no unifying explanation over all the HIV-CD8E scenarios.
format Article
author Lucas, Sebastian B.
Wong, Kum T.
Nightingale, Sam
Miller, Robert F.
Encephalitis, HIV Associated CD8
author_facet Lucas, Sebastian B.
Wong, Kum T.
Nightingale, Sam
Miller, Robert F.
Encephalitis, HIV Associated CD8
author_sort Lucas, Sebastian B.
title HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases
title_short HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases
title_full HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases
title_fullStr HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases
title_full_unstemmed HIV-associated CD8 encephalitis: A UK case series and review of histopathologically confirmed cases
title_sort hiv-associated cd8 encephalitis: a uk case series and review of histopathologically confirmed cases
publisher Frontiers Media
publishDate 2021
url http://eprints.um.edu.my/26478/
_version_ 1735409418033430528
score 13.211869

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