D. Nkoghe

HIV-associated hematologic disorders are correlated with plasma viral load and improve under highly active antiretroviral therapy

&NA; The relationship between HIV‐1 replication and hematologic parameters was examined in two separate studies. The first study was a cross‐sectional evaluation of 207 untreated patients. In this study, the proportion of patients with hematologic disorders increased with disease progression. There was a significant inverse correlation between HIV‐1 plasma viral load and all hematologic values (r = ‐0.266 to ‐0.331). The second study was a longitudinal evaluation of patients on combination antiretroviral therapy (HAART) with hematologic alterations before treatment (N = 27 with platelets <150,000/μl, 24 with hemoglobin <12 g/dl, 36 with neutrophils <2000/&mgr;l and 29 with leukocytes <3000/&mgr;l). Samples were analyzed every 3 months for 2 years. At 2 years, >50% of patients experienced a sustained virologic response, with viral loads <500 RNA copies/ml. Hematologic reconstitution occurred progressively for all blood cell lineages and became statistically significant after the sixth month of therapy (p < .001). Mean values increased from 110 to 180 × 103/&mgr;l for platelets, from 10.7 to 12.3 g/dl for hemoglobin (stabilizing finally at 11.4 g/dl), from 1,260 to 2,240/&mgr;l for neutrophils, and from 2,260 to 3,600/&mgr;l for leukocytes. In conclusion, hematologic disorders are corrected by combination antiretroviral therapy. This suggests a causative role of HIV‐1 in hematologic disorders.

Lesions cerebrales demyelinisantes decouvertes chez un patient immunocompetent VIH-1+.

We report the case of a 32-year-old immunocompetent HIV patient, presenting with acute demyelinating leukoencephalopathy. The patient displayed clinical and radiological features similar to multiple sclerosis. Histology revealed inflammation with necrosis, demyelination and destruction of axons. Serum tests were negative for various infectious agents as well as specific cultures and PCR. Corticotherapy and many antibiotic treatments failed. Resorption of the lesions occurred after partial excision and highly-active antiretroviral therapy (HAART). No recurrence was noted. This demyelinating cerebral disease was considered as the primary manifestation of HIV infection. HIV implication in the genesis of the process and its perpetuating this condition was suspected, but the mechanism is unclear. Dysimmune consequences related to the early course of HIV infection could be prevented by antiretroviral treatment. This study was the first description of tritherapy effectiveness on HIV related multiple sclerosis (MS)-like illness.