{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T17:39:04Z","timestamp":1786556344319,"version":"build-2736575974"},"reference-count":6,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2026,8,2]]},"abstract":"<jats:p>We describe a 54-year-old woman living with HIV who presented with a tonic-clonic seizure and rapidly progressive encephalitis. Despite an undetectable plasma viral load while taking Biktarvy, initial investigations revealed cerebrospinal fluid escape with an HIV viral load of 474 copies\/mL. Extensive testing for opportunistic infections and autoantibodies was negative. Brain biopsy and metagenomic next-generation sequencing identified frequent CD8+ T-cell infiltration and human pegivirus, though the latter was deemed a bystander. The patient\u2019s condition improved significantly, notably without the high-dose corticosteroids typically required for CD8+ encephalitis. This recovery suggests a moderate, self-limiting phenotype of the disease. The case highlights the diagnostic utility of metagenomics in complex presentations while cautioning against the misinterpretation of non-pathogenic commensals.<\/jats:p>","DOI":"10.1136\/pn-2026-005308","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T17:20:30Z","timestamp":1786555230000},"page":"pn-2026-005308","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["HIV-associated CD8 encephalitis: role of metagenomics in complex CNS presentations"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5437-2605","authenticated-orcid":false,"given":"Gavin","family":"Deas","sequence":"first","affiliation":[{"name":"University of Bristol, Bristol, UK"},{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Macgregor","sequence":"additional","affiliation":[{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Kite","sequence":"additional","affiliation":[{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1250-5693","authenticated-orcid":false,"given":"Hannah","family":"Ward","sequence":"additional","affiliation":[{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"May","sequence":"additional","affiliation":[{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Powell","sequence":"additional","affiliation":[{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Jenkins","sequence":"additional","affiliation":[{"name":"NHS North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"2026081210201948000_pn-2026-005308v1.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2022.e09950","article-title":"The role of CCR5 in HIV-associated neurocognitive disorders","volume":"8","author":"Riviere-Cazaux","year":"2022","journal-title":"Heliyon"},{"key":"2026081210201948000_pn-2026-005308v1.2","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.628296","article-title":"HIV-Associated CD8 Encephalitis: A UK Case Series and Review of Histopathologically Confirmed Cases","volume":"12","author":"Lucas","year":"2021","journal-title":"Front Neurol"},{"key":"2026081210201948000_pn-2026-005308v1.3","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1056\/NEJMc2501512","article-title":"Pegivirus-Associated Encephalomyelitis in Immunosuppressed Patients","volume":"392","author":"Scheibe","year":"2025","journal-title":"N Engl J Med"},{"key":"2026081210201948000_pn-2026-005308v1.4","doi-asserted-by":"crossref","DOI":"10.3390\/tropicalmed10020045","article-title":"HIV Cerebrospinal Fluid Escape: Interventions for the Management, Current Evidence and Future Perspectives","volume":"10","author":"Kelly","year":"2025","journal-title":"Trop Med Infect Dis"},{"key":"2026081210201948000_pn-2026-005308v1.5","doi-asserted-by":"crossref","first-page":"401","DOI":"10.4149\/av_2017_402","article-title":"The human pegivirus: A new name for an \u201cancient\u201d virus. Can transfusion medicine come up with something new?","volume":"61","author":"Marano","year":"2017","journal-title":"Acta Virol"},{"key":"2026081210201948000_pn-2026-005308v1.6","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s40291-024-00727-9","article-title":"Clinical Metagenomic Next-Generation Sequencing for Diagnosis of Central Nervous System Infections: Advances and Challenges","volume":"28","author":"Su","year":"2024","journal-title":"Mol Diagn Ther"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2026-005308","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T17:20:31Z","timestamp":1786555231000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2026-005308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":6,"alternative-id":["10.1136\/pn-2026-005308"],"URL":"https:\/\/doi.org\/10.1136\/pn-2026-005308","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}