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Abstract

Guillain–Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients.

A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up.

This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive.

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2017-08-08
2020-01-29
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References

  1. Pithadia AB, Kakadia N. Guillain–Barré syndrome (GBS). Pharmacol Rep 2010;62:220–232 [CrossRef][PubMed]
    [Google Scholar]
  2. Van Doorn PA. Diagnosis, treatment and prognosis of Guillain–Barré syndrome (GBS). Presse Med 2013;42:e193e201 [CrossRef][PubMed]
    [Google Scholar]
  3. Yuki N, Hartung HP. Guillain–Barré syndrome. N Engl J Med 2012;366:2294–2304 [CrossRef][PubMed]
    [Google Scholar]
  4. Orlikowski D, Porcher R, Sivadon-Tardy V, Quincampoix JC, Raphaël JC et al. Guillain–Barré syndrome following primary Cytomegalovirus infection: a prospective cohort study. Clin Infect Dis 2011;52:837–844 [CrossRef][PubMed]
    [Google Scholar]
  5. Dalton HR, Kamar N, Van Eijk JJ, Mclean BN, Cintas P et al. Hepatitis E virus and neurological injury. Nat Rev Neurol 2016;12:77–85 [CrossRef][PubMed]
    [Google Scholar]
  6. Rozé B, Najioullah F, Fergé JL, Apetse K, Brouste Y et al. Zika virus detection in urine from patients with Guillain–Barré syndrome on Martinique, January 2016. Euro Surveill 2016;21:pii=30154 [CrossRef][PubMed]
    [Google Scholar]
  7. Hellmuth J, Fletcher JL, Valcour V, Kroon E, Ananworanich J et al. Neurologic signs and symptoms frequently manifest in acute HIV infection. Neurology 2016;87:148–154 [CrossRef][PubMed]
    [Google Scholar]
  8. British HIV Association 2008; UK National guidelines for HIV testing. www.bashhguidelines.org/media/1067/1838.pdf
  9. Shepherd SJ, Mcallister G, Kean J, Wallace LA, Templeton KE et al. Development of an avidity assay for detection of recent HIV infections. J Virol Methods 2015;217:42–49 [CrossRef][PubMed]
    [Google Scholar]
  10. Pardo CA, Mcarthur JC, Griffin JW. HIV neuropathy: insights in the pathology of HIV peripheral nerve disease. J Peripher Nerv Syst 2001;6:21–27 [CrossRef][PubMed]
    [Google Scholar]
  11. Schütz SG, Robinson-Papp J. HIV-related neuropathy: current perspectives. HIV AIDS 2013;5:243–251 [CrossRef][PubMed]
    [Google Scholar]
  12. Espinosa M, Pulido F, Rubio R, Lumbreras C, Del Palacio M. Peripheral facial palsy leading to the diagnosis of acute HIV infection. HIV & AIDS Review 2016;15:88–90 [CrossRef]
    [Google Scholar]
  13. Schleicher GK, Black A, Mochan A, Richards GA. Effect of human immunodeficiency virus on intensive care unit outcome of patients with Guillain–Barré syndrome. Crit Care Med 2003;31:1848–1850 [CrossRef][PubMed]
    [Google Scholar]
  14. Brannagan TH, Zhou Y. HIV-associated Guillain–Barré syndrome. J Neurol Sci 2003;208:39–42 [CrossRef][PubMed]
    [Google Scholar]
  15. Thornton CA, Latif AS, Emmanuel JC. Guillain–Barré syndrome associated with human immunodeficiency virus infection in Zimbabwe. Neurology 1991;41:812–815 [CrossRef][PubMed]
    [Google Scholar]
  16. Sloan DJ, Nicolson A, Miller AR, Beeching NJ, Beadsworth MB et al. Human immunodeficiency virus seroconversion presenting with acute inflammatory demyelinating polyneuropathy: a case report. J Med Case Rep 2008;2:370–375 [CrossRef][PubMed]
    [Google Scholar]
  17. Pontali E, Feasi M, Crisalli MP, Cassola G. Guillain–Barré syndrome with fatal outcome during HIV-1-seroconversion: a case report. Case Rep Infect Dis 2011;2011:1–4 [CrossRef][PubMed]
    [Google Scholar]
  18. Varshney AN, Anand R, Bhattacharjee A, Prasad P, Kumar N et al. HIV seroconversion manifesting as Guillian–Barré syndrome. Chin Med J 2014;127:396[PubMed]
    [Google Scholar]
  19. Fantauzzi A, Digiulio MA, Cavallari EN, D'Ettorre G, Vullo V et al. Guillain Barré syndrome in an HIV-1-infected patient after the beginning of combined antiretroviral therapy: an immune reconstitution inflammatory syndrome?. New Microbiol 2014;37:103–107[PubMed]
    [Google Scholar]
  20. Rosca EC, Rosca O, Simu M. Intravenous immunoglobulin treatment in a HIV-1 positive patient with Guillain–Barré syndrome. Int Immunopharmacol 2015;29:964–965 [CrossRef][PubMed]
    [Google Scholar]
  21. Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC et al. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469–482 [CrossRef][PubMed]
    [Google Scholar]
  22. Spudich S, Gisslen M, Hagberg L, Lee E, Liegler T et al. Central nervous system immune activation characterizes primary human immunodeficiency virus 1 infection even in participants with minimal cerebrospinal fluid viral burden. J Infect Dis 2011;204:753–760 [CrossRef][PubMed]
    [Google Scholar]
  23. Valcour V, Chalermchai T, Sailasuta N, Marovich M, Lerdlum S et al. Central nervous system viral invasion and inflammation during acute HIV infection. J Infect Dis 2012;206:275–282 [CrossRef][PubMed]
    [Google Scholar]
  24. Wang SX, Ho EL, Grill M, Lee E, Peterson J et al. Peripheral neuropathy in primary HIV infection associates with systemic and central nervous system immune activation. J Acquir Immune Defic Syndr 2014;66:303–310 [CrossRef][PubMed]
    [Google Scholar]
  25. Hao S. The molecular and pharmacological mechanisms of HIV-related neuropathic pain. Curr Neuropharmacol 2013;11:499–512 [CrossRef][PubMed]
    [Google Scholar]
  26. Bagashev A, Sawaya BE. Roles and functions of HIV-1 tat protein in the CNS: an overview. Virol J 2013;10:358–378 [CrossRef][PubMed]
    [Google Scholar]
  27. Berth S, Caicedo HH, Sarma T, Morfini G, Brady ST. Internalization and axonal transport of the HIV glycoprotein gp120. ASN Neuro 2015;7:1–15 [CrossRef][PubMed]
    [Google Scholar]
  28. Dahl V, Peterson J, Fuchs D, Gisslen M, Palmer S et al. Low levels of HIV-1 RNA detected in the cerebrospinal fluid after up to 10 years of suppressive therapy are associated with local immune activation. AIDS 2014;28:2251–2258 [CrossRef][PubMed]
    [Google Scholar]
  29. Ferretti F, Gisslen M, Cinque P, Price RW. Cerebrospinal fluid HIV escape from antiretroviral therapy. Curr HIV/AIDS Rep 2015;12:280–288 [CrossRef][PubMed]
    [Google Scholar]
  30. Yilmaz A, Price RW, Gisslén M. Antiretroviral drug treatment of CNS HIV-1 infection. J Antimicrob Chemother 2012;67:299–311 [CrossRef][PubMed]
    [Google Scholar]
  31. Letendre SL, Mills AM, Tashima KT, Thomas DA, Min SS et al. ING116070: a study of the pharmacokinetics and antiviral activity of dolutegravir in cerebrospinal fluid in HIV-1-infected, antiretroviral therapy-naive subjects. Clin Infect Dis 2014;59:1032–1037 [CrossRef][PubMed]
    [Google Scholar]
  32. Murphy G, Pilcher CD, Keating SM, Kassanjee R, Facente SN et al. Moving towards a reliable HIV incidence test – current status, resources available, future directions and challenges ahead. Epidemiol Infect 2017;145:925–941 [CrossRef][PubMed]
    [Google Scholar]
  33. Kassanjee R, Pilcher CD, Keating SM, Facente SN, McKinney E et al. Independent assessment of candidate HIV incidence assays on specimens in the CEPHIA repository. AIDS 2014;28:2439–2449 [CrossRef][PubMed]
    [Google Scholar]
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