LAUSR

A 30-year-old woman of sub-Saharan Africa origin attended our clinic in October 2016 for the follow-up of an HIV-1 infection. A treatment with combivir/ nevirapine was initiated in her country years ago. Laboratory testing indicated a detectable viral load (1420 copies/ml) and genotype testing demonstrated combined nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor resistances with preserved protease-inhibitor sensitivity. CD4þT cells count was 396 cells/ml (18.3%). A combination therapy with darunavir/cobicistat and dolutegravir (DTG) was initiated on 25 January 2017. One month later, viral load was undetectable (<20 copies/ml). No adverse effect was reported. Twenty-eight weeks after treatment switch, the patient attended the outpatient clinic complaining of tremor of both arms since 5 days. Physical examination revealed grade 2 rigidityon theUnified Parkinson’s Disease Rating Scale (UPDRS) [1] of both arms along with tremor of both arms, more severe for the right arm (Video 1, http://links.lww.com/QAD/B410). A light tremor of the lower limbs was also noted. There was no gait instability nor walking abnormalities. Body weight was 75 kg. DTG was stopped and switched to raltegravir 800 mg 1x/d, while darunavir/cobicistat was continued. Six days after DTG discontinuation, tremorof the left arm was no longer observed, but there was a persistence of tremor of the right arm (Video 2, http://links.lww.com/QAD/B411). A brain MRI did not show any brain nor vascular lesion. A dopamine transporter (DAT) single photon emission computerized tomography was performed and revealed no abnormalities. Thyroid function tests were within normal range. The patient did not take other medications apart from antiretroviral therapy and did not report consumption of recreative drugs. Viral load after switch remained undetectable. Three months after treatment switch, minimal tremor of the right arm was still present, but rigidity of the upper limbs was no longer observed (Video 3, http://links.lww.com/QAD/B412). Six months after treatment switch, physical examination was normal with absence of tremor and rigidity.