Cerebellar Ataxia in HIV Patient due to Suspected Efavirenz Associated Neurotoxicity

Objective: To report a rare presentation of efavirenz associated cerebellar ataxia in a patient of HIV/AIDS. Background: A 35-year-old gentleman presented with one week history of acute onset cerebellar atxaia. Neurological examination revealed scanning speech, dysmetria, dysdiadochokinesia, gait ataxia and irrelevant talking. No sensory or motor deficit was present. Patient was a known case of Pulmonary kochs and HIV AIDS, already on antiretroviral and anti-tubercular treatment. Patient was taking Efavirenz 600 mg daily along with Tenofovir and Lamivudine for HIV. No abnormality was found on MRI brain with contrast. Chest X-ray and abdominal ultrasonography was normal. CD4 count was 520 cells/microlitre. CSF examination revealed mildly elevated protein (62 mg/dl), normal sugar (68 mg/dl) and normal cell count. CSF for AFB, bacterial culture, GenXpert, fungal culture, India ink was negative. Discussion and Conclusion: For a known case of HIV AIDS on antiretroviral treatment, in the absence of any structural abnormality on MRI brain, a possibility of cerebellar dysfunction as a result of efavirenz associated neurotoxic side effect can be considered.