HIV & CNS

A 30-year-old male was brought to the emergency department with drowsiness. The patient was complaining of a persistent headache recently. On examination, he has a GCS of 13, a fever of 100^oF, and signs of meningeal irritation were absent. CT brain showed multiple ring-enhancing lesions. Which of the following is the most likely diagnosis?

A 34-year-old HIV-positive male presents to the emergency department with a 2-week history of headache, fever, blurring of vision, and eye pain for 3 weeks. He has been non-adherent to antiretroviral therapy (ART) for the past 8 months.

On examination, his temperature is 38.2°C (100.8°F). Fundoscopic examination shows no signs of chorioretinitis.

Laboratory findings include:

• CD4 count: 45 cells/mm³
• HIV viral load: 150,000 copies/mL
• Brain MRI shows multiple ring-enhancing lesions with surrounding edema, predominantly in the basal ganglia and corticomedullary junction.

Which of the following is the most appropriate initial treatment?

A 40-year-old HIV-positive male presents to the emergency department with a 2-week history of headache, fever, and progressive confusion. His partner reports that he has also experienced photophobia and occasional vomiting. He has been non-adherent to his antiretroviral therapy (ART) for the past year.

On examination, his temperature is 38.5°C (101.3°F), and he appears confused and disoriented. There are no focal neurological deficits, but neck stiffness is noted. Fundoscopy shows mild papilledema.

Laboratory findings reveal:

• CD4 count: 30 cells/mm³
• Cerebrospinal fluid (CSF) analysis:
  • Opening pressure: 300 mmH₂O
  • WBC count: 30 cells/µL (lymphocytic predominance)
  • Protein: 85 mg/dL
  • Glucose: 35 mg/dL (serum glucose: 100 mg/dL)
  • India ink stain: Positive

What is the most appropriate treatment?

A 44-year-old rickshaw driver presents with 6 months of progressive memory loss and fatigue. His family reports he frequently forgets routes and passenger fares, requiring written reminders. He has stopped playing cricket due to an unsteady gait and poor coordination. For the past 2 weeks, he has had difficulty swallowing. On examination, his temperature was 100^oF, oral thrush, limb ataxia, dysdiadokokinesia, and short-term memory impairment

His investigation showed Normal blood glucose, TSH, vitamin B12 level, and esophageal candidiasis on endoscopy. Which of the following is the most likely underlying cause of this patient’s neurological symptoms?

A 52-year-old shopkeeper from Rawalpindi is brought to Holy Family Hospital with 3 weeks of worsening headaches, dizziness, and personality changes. He was diagnosed with HIV 14 years ago at a local clinic, but has been inconsistent with his antiretroviral therapy (ART). His wife reports he recently restarted taking his medications regularly, including cotrimoxazole prophylaxis.

On examination he has ataxia, apathy and confusion, afebrile and normal blood pressure. His investigations showed

• CD4 count: 90/mm³
• TLC: 8400, Hb, 11.9 g/dl, Platelets 352000
• MRI brain: Solitary ring-enhancing lesion involving the corpus callosum
• CSF analysis: Slight pleocytosis, PCR for EBV DNA was positive

Which of the following is the most likely diagnosis?