SHM Converge Scientific Abstract ePoster Gallery-A Case Report of Acute Hiv Infection Associated Encephalopathy

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This case describes a 53-year-old woman with hypertension who was admitted after three days of worsening confusion, aphasia, poor oral intake, and urinary incontinence. On exam, she was oriented only to person and place, spoke minimally, and had hyperreflexia but no focal deficits. Initial workup, including CT head, lumbar puncture, infectious studies, toxicology, and routine labs, was largely unrevealing. Brain MRI showed patchy T2 hyperintensities in the periventricular and peripheral white matter with frontal predominance and pontine involvement.<br /><br />An HIV antibody screen was reactive, and despite negative confirmatory testing initially, further evaluation revealed a very high HIV viral load of 10 million and a CD4 count of 551. During hospitalization she developed waxy posturing and catatonia. She was started on Biktarvy for HIV and lorazepam for catatonia, with input from Neurology, Psychiatry, Infectious Disease, and social support services.<br /><br />Her mental status and catatonia improved after antiretroviral therapy was started. Before discharge, she could answer questions and follow commands, though she still could not independently manage activities of daily living and required maximal home health support and close follow-up.<br /><br />The case emphasizes that acute HIV infection should be considered in the differential diagnosis of reversible encephalopathy and neuropsychiatric change. It also highlights that HIV-associated neurocognitive disorder can present with confusion, aphasia, and catatonia, and that prompt antiretroviral treatment plus multidisciplinary care can improve outcomes.

Asset Subtitle

Colleen Long

Meta Tag

Author List Alan Roberts, Colleen Long, David Scudder, Katherine Julian, Lauren Dailey, Libby Greenwell

Category Clinical Vignettes

Concept Acute HIV Infection

Concept HIV-Associated Neurocognitive Disorder

Concept HIV Therapy

Concept Encephalopathy

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization University of Colorado

Presenting Author Colleen Long

Track Adult

Keywords

acute HIV infection

encephalopathy

catatonia

aphasia

confusion

HIV-associated neurocognitive disorder

antiretroviral therapy

Biktarvy

white matter hyperintensities

multidisciplinary care

Acute HIV Infection

HIV-Associated Neurocognitive Disorder

HIV Therapy

Encephalopathy

Altered Mental Status