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J Infect Dis. 2017 Jan 1;215(1):105-113. doi: 10.1093/infdis/jiw505. Epub 2016 Oct 26.

Prevalence and Correlates of Persistent HIV-1 RNA in Cerebrospinal Fluid During Antiretroviral Therapy.

Author information

1
Emory University School of Medicine, Atlanta, Georgia.
2
Germans Trias i Pujol University Hospital, Barcelona, Spain.
3
bioMONTR Labs, Research Triangle Park, North Carolina.
4
University of California, San Diego.
5
Washington University, St. Louis, Missouri.
6
University of Washington, Seattle.
7
University of Texas Medical Branch, Galveston.
8
Johns Hopkins University, Baltimore, Maryland.
9
Icahn School of Medicine at Mount Sinai, New York.

Abstract

BACKGROUND:

 Neurocognitive disorders remain common among human immunodeficiency virus (HIV)-positive adults, perhaps owing to persistent HIV-1 RNA in cerebrospinal fluid (CSF) during antiretroviral therapy (ART).

METHODS:

 Using a single-copy assay, we measured HIV-1 RNA levels in CSF and plasma specimens from 220 HIV-positive adults who were taking suppressive ART. Fifty-five participants were tested twice.

RESULTS:

 HIV-1 RNA was detected in 42.3% of CSF and 65.2% of plasma samples. Correlates of higher CSF HIV-1 RNA levels included higher nadir and current CD4+ T-cell counts, a plasma HIV-1 RNA level of ≥ 1 copy/mL, and a lower central nervous system penetration-effectiveness score (model P < .001). Worse neurocognitive performance was associated with discordance in HIV-1 RNA detection between plasma and CSF, lower overall CSF HIV-1 RNA level, and longer ART duration, among others (model P < .001). In the longitudinal subgroup, CSF HIV-1 RNA persisted in most participants (69%) over 7 months.

CONCLUSIONS:

 Low-level HIV-1 RNA in CSF is common during suppressive ART and is associated with low-level HIV-1 RNA in blood, better immune status, and lower ART drug distribution into CSF. The association between HIV-1 RNA discordance and HIV-associated neurocognitive disorder (HAND) may reflect compartmentalization. The relationship between HAND, lower HIV-1 RNA levels in CSF, and lower CD4+ T-cell counts may reflect disturbances in the immune response to HIV-1 in the CNS.

KEYWORDS:

HIV; antiretroviral therapy; cerebrospinal fluid; cognitive disorders

PMID:
27789723
PMCID:
PMC5225254
DOI:
10.1093/infdis/jiw505
[Indexed for MEDLINE]
Free PMC Article

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