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LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 4  |  Page : 560

Guillain-Barre syndrome presenting in the anti-HIV seroconversion period


eurology Unit, Department of Neurological Sciences, Christian Medical College Hospital, Vellore - 632004

Correspondence Address:
eurology Unit, Department of Neurological Sciences, Christian Medical College Hospital, Vellore - 632004
sk@cmcvellore.ac.in



How to cite this article:
Kumar S, Alexander M, Markandeyulu V, Gnanamuthu C. Guillain-Barre syndrome presenting in the anti-HIV seroconversion period. Neurol India 2003;51:560


How to cite this URL:
Kumar S, Alexander M, Markandeyulu V, Gnanamuthu C. Guillain-Barre syndrome presenting in the anti-HIV seroconversion period. Neurol India [serial online] 2003 [cited 2014 Sep 30];51:560. Available from: http://www.neurologyindia.com/text.asp?2003/51/4/560/5045


Sir,
Guillain-Barre syndrome (GBS) has been reported in HIV infection.[1],[2],[3],[4] The long-term outcome of these patients is not well known. We describe a case of GBS occurring in the acute anti-HIV seroconversion period.
A 21-year-old man presented with 3-day history of weakness of all four limbs, 1-day history of dysphagia, dysarthria and breathlessness and paresthesia of hands and feet. Power was Grade 2/5 and 0/5 in the upper and lower limbs respectively. All reflexes were absent. Nerve conduction studies showed features of demyelinating polyradiculoneuropathy. Cerebrospinal fluid (CSF) analysis showed a total WBC count of 30/cu.mm with 55% lymphocytes. CSF protein was 98 mg% and sugar was 108 mg%. A diagnosis of GBS was made.
Serum HIV testing results were as follows: Rapid test and ELISA I were negative. ELISA II showed a weak reactivity. Immunoblot showed reactivity to gp41 and p24 antigens. Repeat testing 6 days later showed reactivity to both ELISA I and ELISA II and immnuoblot positive for HIV-1. These results were suggestive of acute anti-HIV seroconversion state and it was concluded that the GBS in this patient was related to this.
He was treated with plasmapheresis. He started improving within a week and was weaned off the ventilator 3 weeks later. He was functionally independent at 3-month follow up. At the last follow-up 4 years after the initial diagnosis, he had no deficits.
The 2 larger studies[2],[3] on the association of GBS and HIV infection are from Africa. A high prevalence of HIV infection (among those with GBS) was found- 55% in Zimbabwe[2] and 30.5% in the Tanzania[3] study. GBS was the presenting illness in all of them as seen in our case too. The duration between the onset to the peak of illness varied from 24 days in the Zimbabwe study[2] to only 2.5 days in the Tanzania study.[3] Our patient reached the peak of illness on the third day. Nerve conduction studies do not differ significantly between HIV-positive and HIV-negative groups. CSF analysis shows a greater degree of pleocytosis[2] in the HIV-positive group. CD4 count is normal as GBS usually occurs early in the illness. Both plasmapheresis[5] and intravenous immunoglobulins (IVIG)[4] have been used to treat GBS in HIV-seropositive individuals. The reported results have ranged from ineffective and mild benefit to good[5] response. Our patient had an excellent response. Outcomes after ICU care were found to be similar in HIV-positive and HIV-negative patients with GBS.[6] This is encouraging evidence for all who care for HIV-positive GBS patients.
There is insufficient data on the long-term outcome in HIV-positive GBS patients. A retrospective study of 10 patients has reported a recurrence of GBS in 3 (30% of cases) in a period between 9 weeks to 4 years.[7] However, a 4-year follow up of our case has shown a good long-term outcome without any recurrence.
In conclusion, GBS in an HIV-positive patient should be aggressively treated and ICU care with mechanical ventilation provided, if required, as the outcome is satisfactory. 

     References Top

1.Satishchandra P, Nalini A, Gourie-Devi M, Khanna N, Santosh V, Ravi V, et al. Profile of neurologic disorders associated with HIV/AIDS from Bangalore, South India (1989-96). Indian J Med Res 2000;111:14-23  Back to cited text no. 1  [PUBMED]  
2.Thornton CA, Latif AS, Emmanuel JC. Guillain-Barre syndrome associated with human immunodeficiency virus infection in Zimbabwe. Neurology 1991;41:812-5.   Back to cited text no. 2  [PUBMED]  
3.Howlett WP, Vedeler CA, Nyland H, Aarli JA. Guillain-Barre syndrome in northern Tanzania: a comparison of epidemiological and clinical findings with western Norway. Acta Neurol Scand 1996;93:44-9.  Back to cited text no. 3  [PUBMED]  
4.Hassan KM, Mathew I. Guillain Barre' syndrome-in an HIV seropositive subject. J Assoc Physicians India 2000;48:1214  Back to cited text no. 4  [PUBMED]  
5.Berger JR, Difini JA, Swerdloff MA, Ayyar DR. HIV seropositivity in Guillain-Barre syndrome. Ann Neurol 1987;22:393-4.  Back to cited text no. 5  [PUBMED]  
6.Schleicher GK, Black A, Mochan A, Richards GA. Effect of human immunodeficiency virus on intensive care unit outcome of patients with Guillain-Barre syndrome. Crit Care Med 2003;31:1848-50.  Back to cited text no. 6    
7.Brannagan TH 3rd, Zhou Y. HIV-associated Guillain-Barre syndrome. J Neurol Sci 2003;208:39-42.  Back to cited text no. 7    

 

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