Original article HAART, HIV correlated pathologies and other infections ~ 2011 390 Introduction HIV infection is an important cause of inflamma- tory neuropathies in fact demyelinating polyneu- ropathies are diagnosed in a third of HIV+ pa- tients referred for peripheral nerve disease (1,2). It is possible to distinguish two forms of disease: acute and chronic demyelinating polyneuropathy (AIDP and CIDP). The AIDP had a rapid onset and progression, and often develops during HIV sero- conversion or during early HIV infection. On the other hand CIDP is more common in middle to late stages of HIV disease and had a slower onset and progression over several weeks or months. HIV- related inflammatory neuropathies can be further distinguished into a subtype associated with HIV infection per se and an antiretroviral toxic neu- ropathy associated with the use of antiretroviral agents. AIDP and CIDP are both characterized by progressive, ascending weakness with early loss of reflexes (3,4). The response to immune-based therapies (including plasmapheresis or intravenous immunoglobulin) is similar to that seen in non-HIV-associated AIDP and CIDP (5). In this report we present the case of a severe HIV-1 related AIDP which improved after protease inhibitors initiation and without the use of immune-based therapies. HAART, HIV correlated pathologies and other infections Fernanda Altavilla*, Giancarlo Ceccarelli*, Cecilia Rizza*, Francesca Gizzi*, Francesca Tierno*, Alessandro Clemenzi+, Giovanni Antonini+, Gabriella d’Ettorre* and Vincenzo Vullo* Darunavir and acute HIV-related demyelinating polyneuropathy: a new possible treatment? Case report In July 2009, a 32-year old heterosexual and drug abuser man was diagnosed HIV-1 infection after the onset of fever, abdominal cramps, and difuse lymph- adenopathy. His past medical history was notable only for chronic hepatitis C infection. In September 2009 the CD4+ count was 550 (23%) and the wild-type HIV-RNA was 119,979 copies/ml. In February 2010, the CD4+ T cell-count showed a re- duction to 453 cells/mmc and a therapy with boosted Darunavir plus Tenofovir/Emtricitabine was pre- scribed, which the patient refused to take. In April 2010, the patient complained the acute onset of paresthesia/ hypoesthesia in the soles of the feet, which within 20 days spread up to the gluteal region, and to the hands up to the wrists, also associated with weakness of the lower limbs. he patient accepted to start the antiretroviral therapy that had been prescribed before, with subjective im- provement in both sensory and motor symptoms after one week. Neurological examination, performed af- ter an additional week, revealed strength impairment (MRC scale grade 4) in extensor digitorum, hand’s in- terossei, tibialis anterior and extensor allucis longus muscles of the two sides, both pain hypoesthesia and hypopallesthesia (7/8 on the tuning-fork exam) in the feet up to the ankles and in the hand ingers, arelexia * Department of Public Health and Infectious Diseases, “Sapienza” University of Rome + Department of Neurological Science, II “Sapienza” University of Rome Corresponding author: Giancarlo Ceccarelli , MD Department of Public Health and Infectious Diseases, “Sapienza” University of Rome Tel +39-06/49970313 e-mail: giancarlo.ceccarelli@uniroma1.it Key words: generic drug, co-formulation, antiretroviral therapy At this moment the role of new protease inhibitors in the onset of HIV-related demyelinating polyneuropathy remains a controversial topic. We describe the improvement of AIDP after introduction of boosted Darunavir plus Tenofovir/ Emtricitabine in a HIV positive patient naïve for antiretroviral therapy. The regression of the neurological symptoms was associated with the introduction of protease inhibitors in absence of traditional treatment strategies for demyelinating polyneuropathy. Further studies are needed to establish their potential use in the treatment of HIV-1 related demyelinating polyneuropathy.