An HIV-1 Positive Woman Without Usual Immunodeficiency

Introduction: Acquired immune deficiency syndrome (AIDS) inflicts severe damage to the immune system. It transmits from one person to another through blood transfusions and vertical and sexual transmission. It should be noted that almost all papers reporting AIDS emphasized that HIV led to immune deficiency. However, this study reported the first HIV-1 seropositive woman who had an active viral load of HIV-1 without any signs or CD4 lymphocyte count depletion. Case Presentation: This study, for the first time, reported a 46-year-old HIV-1 seropositive woman without any signs and symptoms diagnosed 31 years ago by laboratory tests. Also, it is noteworthy that the patient had not received regular therapeutics during the infection period. Our serologic tests showed an active seropositive patient without any CD4 depletion. The viral load of HIV-1 was 132967.2 u/L, which was quantified by a real-time PCR assay. Also, a CBC test was performed and showed no abnormal results. Conclusions: An untreated HIV-1 positive patient without immunodeficiency is a rare condition, and we found no report of it in the literature. This article reported an HIV-1 positive patient in whom the infection was confirmed several times using the real-time PCR method.

2696. Breakthrough Toxoplasmosis While on Atovaquone Prophylaxis Following Allogeneic Hematologic Stem Cell Transplantation

Background The opportunistic parasite Toxoplasma causes life-threatening complications in immunocompromised hosts such as hematopoietic cell transplantation (HCT) recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the agent of choice in preventing Pneumocystis jirovecii pneumonia and Toxoplasma, but bone marrow suppression often precludes its use. Broad-spectrum atovaquone also targets protozoan tachyzoite and cyst forms, but few studies examine its efficacy in prophylaxis among this vulnerable population. We present two HCT patients experiencing breakthrough toxoplasmosis despite compliance with atovaquone prophylaxis. Methods Review of literature and electronic medical records. Results Case 1. A 68-year-oldToxoplasma seropositive woman with myelodysplastic syndrome underwent Flu-Mel-ATG-matched unrelated donor HCT. On day +68 post HCT, she presented with encephalopathy. MRI brain revealed solid and ring-enhancing lesions correlating with positive CSF T. gondii PCR. Serum DNA PCR was negative. She received 12 weeks of sulfadiazine, pyrimethamine, and leucovorin with clinical and radiological improvement. Atovaquone prophylaxis was restarted given pancytopenia intolerance of TMP-SMX. Despite compliance, she experienced recurrent central nervous system toxoplasmosis. Her demise followed an unrelated ischemic cerebrovascular accident. Case 2. A 53-year-old Toxoplasma seropositive woman with CMV viremia and severe aplastic anemia limiting TMP-SMX use presented with pancytopenia on day +46 after HCT. Diagnosed with graft failure, routine screening revealed positive Toxoplasma PCR while on atovaquone prophylaxis. Toxoplasma PCR became negative after preemptive therapy. She underwent a second Flu-Cy-ATG-TBI-matched related donor HCT. 2 months later, medication noncompliance led to readmission with CMV viremia and culture-negative sepsis. Blood Toxoplasma PCR was positive at the time of death. Conclusion Toxoplasmosis prophylaxis failure can occur in allogeneic HCT recipients receiving atovaquone. When possible, TMP-SMX should remain first-line agent for this indication. In those unable to tolerate TMP-SMX, close clinical and Toxoplasma PCR monitoring may help identify reactivation and facilitate early initiation of therapy. Disclosures All authors: No reported disclosures.

Dramatic HIV DNA degradation associated with spontaneous HIV suppression and disease-free outcome in a young seropositive woman following her infection

ABSTRACTStrategies to cure HIV-infected patients by virus-targeting drugs have failed to date. We identified a HIV-1-seropositive woman who spontaneously suppressed HIV replication and had normal CD4-cell counts, no HIV disease, no replication-competent virus and no cell HIV DNA detected with a routine assay. We suspected that dramatic HIV DNA degradation occurred postinfection. We performed multiple nested-PCRs followed by Sanger sequencing and applied a multiplex-PCR approach. Furthermore, we implemented a new technique based on two hybridization steps on beads prior to next-generation sequencing that removed human DNA then retrieved integrated HIV sequences with HIV-specific probes. We assembled ≈45% of the HIV genome and further analyzed the G-to-A mutations putatively generated by cellular APOBEC3 enzymes that can change tryptophan codons into stop codons. We found more G-to-A mutations in the HIV DNA from the woman than in that of her contaminator. Moreover, 74% of the tryptophan codons were changed to stop codons (25%) or were deleted as a possible consequence of gene inactivation. Finally, we found that this woman’s cells remained HIV-susceptible in vitro. Our findings show that she does not exhibit innate HIV resistance but has been cured of it by extrinsic factors, a plausible candidate for which is the gut microbiota.

Role of Defective Thymic Function in Onset of Ganciclovir-Resistant Cytomegalovirus after Cord Blood Transplantation

ABSTRACTA case of recurrent cytomegalovirus reactivations in a cytomegalovirus-seropositive woman who received allogeneic cord blood transplantation is described. Thirteen months posttransplantation, her CD3+T cell count was extremely low whereas natural killer cells represented 66% of her total lymphocytes. She showed defective thymic function that might contribute to the onset of valganciclovir resistance.

Toxic epidermal necrolysis and its impact on physiotherapy management: a case report

The purpose of this paper is to report on the modified physiotherapy intervention for toxic epidermal necrolysis (TEN) in a 31 year old pregnant human immunodeficiency virus (HIV) seropositive woman on antiretroviral therapy. Physiotherapy intervention consisted of nebulisation and the active cycle of breathing technique in order to clear secretions. To restore lung volumes, the active cycle of breath-ing technique was utilized in addition to positive expiratory pressure, incentive spirometry and positioning. Passive and active exercises and stretches were employed to maintain and regain range of motion in affected limbs. Following intervention, positive changes were noted in outcome measures such as secretion clearance, breath sounds and general function. It is concluded that physiotherapy intervention has a role to play in the rehabilitation of patients with TEN.