Bypassing nonadherence via PEG in a critically ill HIV-1-infected patient

Jan Leipe (1) , Axel J Hueber (2) , Juergen Rech (2) , Thomas Harrer (2)

1 Medizinische Poliklinik, Ludwig-Maximilians-University Munich
2 Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg

This case study describes a 44-year-old chronically non-adherent HIV-infected male with relapsing, life threatening toxoplasmic encephalitis (TE) and other recurring opportunistic infections. Non-adherence resulted in critical illness, suppressed CD4 lymphocyte count and elevated viral load. In order to bypass the patient's complete psychological aversion to taking medication, and after exhausting various psychological interventions, a percutaneous endoscopic gastronomy (PEG) tube was inserted for delivery of indispensable medication. During the 15 month follow-up, the patient was adherent, exhibiting a consistently undetectable viral load, high CD4 count and a remission of the opportunistic infections. This is an interesting case study demonstrating life-saving and long-term benefit of PEG in an exceptional setting, which has implications for future research and treatment of non-adherent HIV-infected patients.

Mots clés: Life Sciences

Jan Leipe, Axel J Hueber, Juergen Rech, Thomas Harrer. Bypassing nonadherence via PEG in a critically ill HIV-1-infected patient. AIDS Care, 2008, 20 (07), pp.863-867. ⟨10.1080/09540120701767182⟩. ⟨hal-00513439⟩