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Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load

  • Author(s): Peluso, MJ
  • Ferretti, F
  • Peterson, J
  • Lee, E
  • Fuchs, D
  • Boschini, A
  • Gisslén, M
  • Angoff, N
  • Price, RW
  • Cinque, P
  • Spudich, S
  • et al.

Published Web Location

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881435/
No data is associated with this publication.
Abstract

OBJECTIVE: To characterize HIV-infected patients with neurosymptomatic cerebrospinal fluid (CSF) 'escape', defined as detectable CSF HIV RNA in the setting of treatment-suppressed plasma levels or CSF RNA more than 1-log higher than plasma RNA. DESIGN: Retrospective case series. SETTING: Four urban medical centers in the United States and Europe. PARTICIPANTS: Virologically controlled HIV-infected patients on antiretroviral therapy (ART) with progressive neurologic abnormalities who were determined to have CSF 'escape'. INTERVENTION: Optimization of ART based upon drug susceptibility and presumed central nervous system exposure. MAIN OUTCOME MEASURES: Levels of CSF HIV RNA and inflammatory markers, clinical signs and symptoms, and MRI findings. RESULTS: Ten patients presented with new neurologic abnormalities, which included sensory, motor, and cognitive manifestations. Median CSF HIV RNA was 3900copies/ml (range 134-9056), whereas median plasma HIV RNA was 62copies/ml (range <50 to 380). Median CD4 T-cell count was 482cells/μl (range 290-660). All patients had been controlled to less than 500copies/ml for median 27.5 months (range 2-96) and five of 10 had been suppressed to less than 50copies/ml for median 19.5 months (range 2-96). Patients had documentation of a stable ART regimen for median 21 months (range 9-60). All had CSF pleocytosis or elevated CSF protein; seven of eight had abnormalities on MRI; and six of seven harbored CSF resistance mutations. Following optimization of ART, eight of nine patients improved clinically. CONCLUSION: The development of neurologic symptoms in patients on ART with low or undetectable plasma HIV levels may be an indication of CSF 'escape'. This study adds to a growing body of literature regarding this rare condition in well controlled HIV infection. © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins.

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