Management of Stage-4 HIV with Cerebral Toxoplasmosis Coinfection and SIADH Complication

Pandu Laksono, Erlin Oktavia, Hidayati Adi Putri, Fauna Herawati

Abstract


HIV/AIDS stage 4 is the stage where the HIV/AIDS patients have low immunity protection against infections, which can led to coinfections and complications. This case report presented an evaluation of the diagnosis and treatment of an HIV/AIDS stage 4 patient with cerebral toxoplasmosis coinfection and SIADH complications. A man (47 years, 35 kg), married with two children, complaining of weakness, nausea, vomiting, weight loss, and low appetite. Sodium level were measured, showing a 117 mg/dL level that continued to decrease throughout the patient's treatment. Five days later, the patient lost his consciousness with a GCS score of 224, indicating severe brain injury, and was diagnosed with cerebral toxoplasmosis based on the result of head CT-SCAN with contrast. On day 6, the patient was tested positive for HIV and diagnosed with stage 4 with an absolute CD4 count of 4 cells/μl. Therapy was provided by giving pyrimethamine-clindamycin therapy for cerebral toxoplasmosis, followed by Tenofovir, Lamivudine, and Evafirenz as antiretroviral therapy. Treatment for hyponatremia was done by administration of 3% NaCl and tolvaptan. The patient started experiencing an improvement in consciousness after the 10th day of medication, and sodium levels fluctuated throughout the treatments. Patient was discharged after 15 days with clinical improvements.

Keywords


HIV, acquired immunodeficiency syndrome, cerebral toxoplasmosis, inappropriate ADH syndrome, anti-retroviral agents, antiparasitic agents, hypertonic sodium chloride solution

Full Text:

PDF

References


  1. UNAIDS. Global HIV Statistics. Fact Sheet 2021. 2021;(June):1–3.
  2. Kemenkes RI. Profil Kesehatan Indonesia. Jakarta: Kementrian Kesehatan Republik Indonesia; 2021. Available from: http://www.kemkes/go.id.
  3. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021. p. 594.
  4. Kemenkes RI. Pedoman Nasional Pelayanan Kedokteran Tata Laksana HIV. Jakarta: Kementrian Kesehatan Republik Indonesia; 2019. Available from: https://kemkes.go.id/id/pnpk-2019---tata-laksana-hiv.
  5. Vidal JE. HIV-Related cerebral toxoplasmosis revisited: current concepts and controversies of an old disease. J Int Assoc Provid AIDS Care. 2019;18:2325958219867315. doi:10.1177/2325958219867315
  6. Luma HN, Tchaleu BCN, Mapoure YN, Temfack E, Doualla MS, Halle MP, et al. Toxoplasma encephalitis in HIV/AIDS patients admitted to the Douala general hospital between 2004 and 2009: A cross sectional study. BMC Res Notes. 2013;6(1):2–6.
  7. Shu Z, Tian Z, Chen J, Ma J, Abudureyimu A, Qian Q. HIV/AIDS-Related hyponatremia: an old but still serious problem. Ren Fail. 2018;0(0):68–74. doi: 10.1080/0886022X.2017.1419975
  8. Krajewska M, Kruczkowska A, Kusztal MA, Królicka AL. Hyponatremia in infectious diseases—a literature review. Int J Environ Res Public Health. 2020;17(15):1–16.
  9. Xu L, Ye H, Huang F, Yang Z, Zhu B, Xu Y, et al. Moderate/Severe Hyponatremia Increases the Risk of Death among Hospitalized Chinese Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients. PLoS One. 2014;9(10):e111077. doi:10.1371/journal.pone.0111077
  10. Musso CG, Belloso WH, Glassock RJ. Water, electrolytes, and acid-base alterations in human immunodeficiency virus infected patients. World J Nephrol 2016; 5(1):33–42
  11. Madariaga H, Kumar A, Khanna A. A rare mechanism of hyponatremia in HIV disease. Am J Case Rep. 2015;16:707–10.
  12. Klatt EC. Pathology of HIV/AIDS Version 28, 33rd ed. J Gen Virol. 2022;91(PT 1):1–545.
  13. Khosla A, Singhal S, Jotwani P, Kleyman R. Cerebral toxoplasmosis as the initial presentation of HIV: A Case Series. Cureus. 2022;14(3):1–8.
  14. Urano K, Ishibashi M, Matsumoto T, Ohishi K, Muraki Y, Iwamoto T, et al. Impact of physician-pharmacist collaborative protocol-based pharmacotherapy management for HIV outpatients: A retrospective cohort study. J Pharm Health Care Sci. 2020;6:9. doi:10.1186/s40780-020-00165-9.
  15. Koshy AA, Harris TH, Lodoen MB. Cerebral toxoplasmosis. Toxoplasma Gondii. Weiss LM, Kim K, editors. Chapter 24 - Cerebral toxoplasmosis. 3rd ed. United States: Academic Press; 2020. p. 1043–73.
  16. Dunay IR, Gajurel K, Dhakal R, Liesenfeld O, Montoya JG. Treatment of toxoplasmosis : historical perspective animal. Clin Microbiol Infect. 2018;31(4):1–33. doi:10.1128/CMR.00057-17
  17. Ben-Harari RR, Goodwin E, Casoy J. Adverse event profile of pyrimethamine-based therapy in toxoplasmosis: a systematic review. Drugs R D. 2017;17(4):523–44. doi:10.1007/s40268-017-0206-8
  18. Wondifraw Baynes H, Tegene B, Gebremichael M, Birhane G, Kedir W, Biadgo B. Assessment of the effect of antiretroviral therapy on renal and liver functions among HIV-infected patients: a retrospective study. HIV AIDS (Auckl). 2016;9:1–7. doi:10.2147/HIV.S120979
  19. Konstantinovic N, Guegan H, Stäjner T, Belaz S, Robert-Gangneux F. Treatment of toxoplasmosis: Current options and future perspectives [published correction appears in Food Waterborne Parasitol. 2020 Dec 15;21:e00105]. Food Waterborne Parasitol. 2019;15:e00036. doi:10.1016/j.fawpar.2019.e00036
  20. Elsheikha HM, Marra CM, Zhu XQ. Epidemiology, Pathophysiology, diagnosis, and management of cerebral toxoplasmosis. Clin Microbiol Rev. 2020;34(1):e00115–19. doi:10.1128/CMR.00115-19
  21. H, Badireddy M. Hyponatremia. [Updated 2023 Jun 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470386/.
  22. Chen S, Zhao JJ, Tong NW, Guo XH, Qiu MC, Yang GY, et al. Randomized, double blinded, placebo-controlled trial to evaluate the efficacy and safety of tolvaptan in Chinese patients with hyponatremia caused by SIADH. J Clin Pharmacol. 2014;54(12):1362–7. doi:10.1002/jcph.342




DOI: https://doi.org/10.15395/mkb.v56.3355

Article Metrics

Abstract view : 1030 times
PDF - 521 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 

View My Stats