Division of Blood Transfusion Medicine and Cell Therapy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Division of Blood Transfusion Medicine and Cell Therapy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
J Infect Chemother. 2020 Feb;26(2):279-281. doi: 10.1016/j.jiac.2019.08.012. Epub 2019 Sep 19.
We report an AIDS patient with a high HIV RNA copy number in the plasma who was successfully treated for prolonged Mycobacterium avium bacteremia and other complications. An HIV-infected patient with high fever, anemia, high alkaline phosphatase, cystic lung lesions, hepatitis B virus infection and Kaposi's sarcoma was referred to our hospital. PCR of the blood revealed Mycobacterium avium bacteremia and the time to blood culture positivity was 8 days. The HIV-1 RNA copy number in the plasma was more than ten million copies/ml and the CD4-positive T cell count was 21 cells/μL. Although the high fever resolved five days after therapy for Mycobacterium avium was started, the fever recurred just before starting anti-retroviral therapy (ART) including dolutegravir. The patient experienced repeated but self-limiting bouts of severe inflammation. Mycobacteremia was intermittently detected up to 79 days, suggesting that the recurrent episodes of inflammation were due to the intermittent dissemination of mycobacteria, and that persistent treatment is needed. Five months after the beginning of ART, the HIV-1 RNA copy number in the plasma was still 28,000 copies/ml. An HIV drug-resistance test revealed sensitivity to all anti-retroviral drugs. Eleven months after the initiation of ART, the HIV RNA copy number in the plasma decreased to 45 copies/mL and the CD4-positive T cell count recovered to 205 cells/μL. Our case also suggests that dolutegravir can be effective in cases with prolonged high levels of HIV RNA. Our findings emphasize that prompt diagnosis and persistent therapy for mycobacterial infection are important for successful treatment.
我们报告了一例 AIDS 患者，其血浆中 HIV RNA 拷贝数高，该患者成功治疗了长时间的鸟分枝杆菌菌血症和其他并发症。一名 HIV 感染患者出现高热、贫血、碱性磷酸酶升高、囊性肺部病变、乙型肝炎病毒感染和卡波西肉瘤，被转至我院。血液 PCR 显示鸟分枝杆菌菌血症，血培养阳性时间为 8 天。血浆中 HIV-1 RNA 拷贝数超过 1000 万拷贝/ml，CD4+T 细胞计数为 21 个/μL。尽管在开始治疗鸟分枝杆菌后 5 天高热消退，但在开始包括度鲁特韦在内的抗逆转录病毒治疗（ART）之前，发热再次复发。患者经历了反复但自限性的严重炎症发作。分枝杆菌血症间歇性检测到 79 天，提示炎症的反复发作是由于分枝杆菌的间歇性播散，需要持续治疗。ART 开始后 5 个月，血浆中 HIV-1 RNA 拷贝数仍为 28000 拷贝/ml。HIV 耐药性检测显示对所有抗逆转录病毒药物均敏感。ART 开始后 11 个月，血浆中 HIV RNA 拷贝数降至 45 拷贝/ml，CD4+T 细胞计数恢复至 205 个/μL。我们的病例还表明，度鲁特韦在 HIV RNA 持续高水平的情况下也可能有效。我们的发现强调了及时诊断和持续治疗分枝杆菌感染对于成功治疗的重要性。
