Infections in HIV
A 29 year old female patient presented with
progressive right sided hemiparesis for past 2
weeks and drowsiness for past 10 days.
She had incontinence of bladder. She was also
having bloody diarhhoea for more than one month.
She had recently been diagnosed as HIV-1 positive
and was ART naïve.
She had a past history of extra-pulmonary
tuberculosis for which she received category-I anti-
Ophthalmological examination done which showed
no features of CMV chorio-retinitis.
Infection with HIV results in progressive depletion of
the CD4 T-lymphocytes and the development of
multiple opportunistic infections (OI) which is a
serious cause of concern regarding outcome.
Anti-Retroviral Therapy (ART) has a profound effect
on the incidence of HIV related OIs and is the key
factor for the decline in observed HIV related
mortality across the globe.
World Health Organization (WHO) recommends
initiation of ART among all HIV infected persons
regardless of WHO clinical stage and CD4 cell count.
But a significant number of ART naïve HIV infected
persons continue to present with advanced disease.
Patient disoriented and drowsy.
GCS- 8/15 (E2V2M4)
Mild pallor - present.
Pulse rate- 70/ minute, regular
Respiratory rate- 24 / minute.
Examination of peri anal region
revealed vesicular eruptions with
satellite ulcerations and discharge
indicating genital herpes.
Oral candidiasis present.
Neck rigidity- present, Kernig’s sign-
Plantar reflex - Bilateral flexor
Pupils- Bilateral mid dilated and
reacting to light.
Muscle tone- increased on right
side compared to left.
Power - diminished (3/5) on the right
side in both upper and lower limbs.
Deep tendon reflexes- Brisk on right
She was started on –
1. Conventional Amphotericin B ( 1
mg/ Kg) daily for Cryptococcal
2. Tab Sulphamethoxazole-
trimethoprim DS- 2 tabs twice
daily for CNS toxoplasmosis
3. Tab Acycolvir (400 mg) thrice
daily for genital herpes
4. Tab Ciprofloxacin (750 mg) twice
daily for diarrhoea
5. Intravenous Dexamethasone (4
mg) twice daily for TBM
6. Empirical category II anti-
tubercular drugs ( Daily regime)
•Director, School of
Kolkata, who has given
us the privilege to
report this case
•The patient, who has
given us the scope to
learn the topic
1. World Health Organization.
Guideline on When to Start
Antiretroviral Therapy and on
Pre-Exposure Prophylaxis for
HIV. Available at
Accessed Nov 25, 2018.
2. Andrea Low, Georgios
Gavriilidis, Natasha Larke,
Marie-Renee B-Lazoie, Olivier
Drouin, JohnStover et al.
Incidence of Opportunistic
Infections and the Impact of
Antiretroviral Therapy Among
HIV-Infected Adults in Low
and Middle Income Countries:
A systemic Review and Meta-
analysis. CID 2016: 62 ; 1595-
Authors: Agnibho Mondal, Avik Medda and Rama Prosad Goswami
Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India
33.9 gm/ dl
hpf, all lymphocytes
in 1:64 dilution
Serum CRAG (
in 1:32 dilution
She showed initial improvement
with the therapy. Her GCS
improved to 10/15 (E4V2M4). The
bloody diarrhea was relieved.
But by the third week of
admission her condition rapidly
deteriorated and she expired.
Occurrence of multiple
AIDS defining OIs in
individual in this report
highlights the need for
early screening and
treatment to improve
Early diagnosis and ART
initiation has a significant
role in reducing HIV
In case of HIV infected
persons receiving ART, a
significant reduction in
the incidence of OIs has
been observed during the
first year ranging from
57% to 91%. 
with low CD4 count
should be searched for
multiple OI and be given
ELISA for HIV I & II
CD4 T lymphocyte count
hyperintensities, focal demyelination with diffuse
suggestive of encephalopathy.
1. Tubercular meningitis
2. CNS toxoplasmosis
3. Cryptococcal meningitis
4. Genital herpes
Presented at ASICON (AIDS Society of India) on November 2, 2018