Clinically Probable Guillain-Barré Syndrome and Herpesvirus-Associated Syndromes in Advanced Untreated HIV: A Retrospective Case Cluster from India.

Abstract

BackgroundGuillain-Barré syndrome (GBS) can be difficult to recognise in advanced untreated HIV, particularly where cerebrospinal fluid analysis and electrophysiology are unavailable.MethodsWe retrospectively reviewed adults with advanced HIV who were not receiving antiretroviral therapy and presented with acute symmetrical weakness at an Indian HIV specialty centre during 2019-2020. Cases were classified as clinically probable GBS with Brighton Collaboration level 3 diagnostic certainty.ResultsEight cases were identified among 139 admissions (5.8%). Mean CD4 count 78 cells/mm³. All eight had multiple concurrent infectious conditions. Herpesvirus-associated syndromes included ulcerative oesophagitis compatible with a herpesvirus-associated process (n=5), antecedent herpes zoster (n=2), or diarrhoeal illness with supportive CMV IgG serology (n=1). Seven recovered after multimodal treatment; one died.ConclusionsThis repeated clinical pattern of coexistence is hypothesis-generating but does not establish active viral reactivation, directionality, or causality. Pragmatic syndromic recognition and treatment remain necessary when definitive diagnostics are unavailable.