Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Dec;29(14):1872-1875.
doi: 10.1177/13524585231199022. Epub 2023 Sep 15.

Therapy challenges for NMOSD in a patient with HIV

Daniel Engels  1 , Joachim Havla  1 , Stefanie Förderreuther  2 , Tania Kümpfel  1
Affiliations
Case Reports

Therapy challenges for NMOSD in a patient with HIV

Daniel Engels et al. Mult Scler. 2023 Dec.

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) in people living with HIV (PLWH) is rare and its management can be difficult. Here we report a case of an HIV patient with bilateral vision loss, who was diagnosed with AQP4-IgG-positive NMOSD in 2020 during the COVID-19 pandemic. Rituximab treatment was initiated after attack therapy with corticosteroids and plasma exchange. NMOSD and HIV disease remained stable, but SARS-CoV-2 immune response after repeated vaccinations was insufficient. After switching immunotherapy due to the lack of vaccination response to satralizumab, peripheral B cells reoccurred and a humoral immune response was observed after reapplication of SARS-CoV-2 vaccination. This case illustrates the challenges associated with the treatment of NMOSD in PLWH.

Keywords: HIV; Neuromyelitis optica (NMO); rituximab; satralizumab.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: DE received speaker honoraria from Alexion/AstraZeneca, JH reports grants for OCT research from the Friedrich-Baur-Stiftung and Merck, personal fees and non-financial support from Celgene, Janssen, Bayer, Merck, Alexion, Novartis, Roche, Biogen, Horizon and non-financial support of the Guthy-Jackson Charitable Foundation, all outside the submitted work, SF has no conflict of interest related to this work, TK has received speaker honoraria and/or personal fees for advisory boards from Roche Pharma, Alexion/Astra Zeneca, Horizon, Chugai and Biogen.

Figures

Figure 1.
Figure 1.
Clinical course, therapy and lab values. Therapy, clinical assessment and laboratory values since the first NMOSD attack. X-axis represents the time line of the disease course since the first NMOSD attack (EDSS: Expanded Disability Status Scale, horizontal dotted line indicates lower normal limit).
See this image and copyright information in PMC

References

    1. Bhigjee AI, Moodley AA, Roos I, et al.. The neuromyelitis optica presentation and the aquaporin-4 antibody in HIV-seropositive and seronegative patients in KwaZulu-Natal, South Africa. South Afr J HIV Med 2017; 18(1): a684. https://sajhivmed.org.za/index.php/hivmed/article/view/684 (accessed 24 November 2022). - PMC - PubMed
    1. Simpson-Yap S, De Brouwer E, Kalincik T, et al.. Associations of disease-modifying therapies with COVID-19 severity in multiple sclerosis. Neurology 2021; 97(19): e1870–e1885. - PMC - PubMed
    1. Apostolidis SA, Kakara M, Painter MM, et al.. Cellular and humoral immune responses following SARS-CoV-2 MRNA vaccination in patients with multiple sclerosis on anti-CD20 therapy. Nat Med 2021; 27(11): 1990–2001. - PMC - PubMed
    1. Härter G, Spinner CD, Roider J, et al.. COVID-19 in people living with human immunodeficiency virus: A case series of 33 patients. Infection 2020; 48(5): 681–686. - PMC - PubMed
    1. Nomah DK, Reyes-Urueña J, Diaz Y, et al.. CD4+ T-cell count below 200 cells/mm3 is associated with worse COVID-19 outcomes among people living with HIV regardless of virological suppression. https://onlinelibrary.wiley.com/doi/10.1002/jia2.25755 (accessed 24 November 2022). - DOI

Publication types