Méchaï Frédéric, Boutolleau David, Manceron Véronique, Gasnault Jacques, Quertainmont Yann, Brosseau Jean-Paul, Delfraissy Jean-François, Labetoulle Marc, Goujard Cécile
Department of Internal Medicine and Infectious Diseases, Bicêtre University Hospital, Le Kremlin Bicêtre Cedex, France.
J Med Virol. 2007 Jul;79(7):931-4. doi: 10.1002/jmv.20833.
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.
与其他疱疹病毒一样，人类疱疹病毒6型（HHV - 6）可在免疫功能低下的患者中重新激活。本文描述了一例感染HIV - 1的患者，其发生了与HHV - 6感染相关的双侧球后视神经炎。一名59岁女性，感染HIV达18年，因治疗失败和严重代谢并发症中断了抗逆转录病毒治疗。随后她出现视力模糊，眼科检查显示因视神经炎导致视力丧失。她的CD4 +细胞计数为285个/立方毫米，血浆HIV - 1 RNA水平为5.5 log(10)拷贝/毫升。脑部磁共振成像正常。脑脊液（CSF）中HHV - 6载量为3.2 log拷贝/毫升，外周血单个核细胞中为6.3 log拷贝/10(6)。开始联合静脉注射膦甲酸钠和更昔洛韦治疗，随后改为西多福韦和长期缬更昔洛韦治疗。尽管脑脊液中HHV - 6载量下降不多，但她的眼部状况逐渐改善。随后给予挽救性抗逆转录病毒治疗，出现明显的免疫和病毒学反应，进一步促进了眼部状况的逐步改善。此前尚未在HIV感染患者中描述过HHV - 6相关的视神经炎。抗HHV - 6治疗改善了患者的视力，但免疫恢复似乎对长期康复仍然至关重要。
