The symptomatology of cerebrospinal fluid HIV RNA escape: a large case-series.
Journal
AIDS (London, England)
ISSN: 1473-5571
Titre abrégé: AIDS
Pays: England
ID NLM: 8710219
Informations de publication
Date de publication:
15 11 2021
15 11 2021
Historique:
pubmed:
16
6
2021
medline:
12
11
2021
entrez:
15
6
2021
Statut:
ppublish
Résumé
To characterize the clinical, laboratory and radiological characteristics of persons with HIV (PWH) presenting with cerebrospinal fluid (CSF) HIV RNA escape. Retrospective case review of PWH presenting with symptomatic CSF HIV RNA escape at seven tertiary HIV clinical sites in the United Kingdom and Italy. PWH with symptomatic CSF HIV RNA escape episodes were identified and data obtained from medical records. CSF HIV RNA escape was defined as quantifiable CSF HIV RNA in unquantifiable plasma HIV RNA or CSF HIV RNA greater than plasma HIV RNA in cases where plasma HIV RNA was quantifiable. The onset of clinical symptoms was classified as acute (<2 weeks-6 months), or chronic (>6 months) and differences in presentation in those with CSF HIV RNA below and above 1000 copies/ml determined. We identified 106 PWH with CSF HIV RNA escape (65 male); 68 (64%) PWH had acute presentations and 38 (36%) had chronic presentations. Cognitive decline (n = 54; 50.9%), confusion (n = 20; 18.9%) and headache (n = 28; 26.4%) were the most common presentations, with cognitive decline being more common in PWH who presented chronically compared with PWH who presented acutely (73.7% vs. 35.3%, P = 0.0002). Sixty PWH had CSF HIV RNA at least 1000 copies/ml and presented more frequently with confusion (n = 15/60; 25.0%) compared with PWH with CSF HIV RNA less than 1000 copies/ml at presentation (n = 5/46; 10.9%; P = 0.03). Cognitive decline, confusion and headache are the most frequent presenting symptoms of CSF HIV RNA escape and their relative frequency varied according to symptom onset and CSF HIV RNA concentration.
Identifiants
pubmed: 34127578
doi: 10.1097/QAD.0000000000002992
pii: 00002030-202111150-00011
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2341-2346Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Yilmaz A, Svennerholm B, Hagberg L, Gisslén M. Cerebrospinal fluid viral loads reach less than 2 copies/ml in HIV-1-infected patients with effective antiretroviral therapy . Antivir Ther 2006; 11:833–837.
Staprans S, Marlowe N, Glidden D, Novakovic-Agopian T, Grant RM, Heyes M, et al. Time course of cerebrospinal fluid responses to antiretroviral therapy: evidence for variable compartmentalization of infection . AIDS 1999; 13:1051–1061.
Enting RH, Prins JM, Jurriaans S, Brinkman K, Portegies P, Lange JMA. Concentrations of human immunodeficiency virus type 1 (HIV-1) RNA in cerebrospinal fluid after antiretroviral treatment initiated during primary HIV-1 infection . Clin Infect Dis 2001; 32:1095–1099.
European AIDS Clinical Society. EACS guidelines . 2018; 9.1. https://www.eacsociety.org/files/2018_guidelines-9.1-english.pdf . [Accessed 7 September 2020].
Winston A, Antinori A, Cinque P, Fox HS, Gisslen M, Henrich TJ, et al. Defining cerebrospinal fluid HIV RNA escape: editorial review AIDS . AIDS 2019; 33:S107.
Ferretti F, Gisslen M, Cinque P, Price RW. Cerebrospinal fluid HIV escape from antiretroviral therapy . Curr HIV/AIDS Rep 2015; 12:280–288.
Canestri A, Lescure F-X, Jaureguiberry S, Moulignier A, Amiel C, Marcelin A, et al. Discordance between cerebral spinal fluid and plasma HIV replication in patients with neurological symptoms who are receiving suppressive antiretroviral therapy . Clin Infect Dis 2010; 50:773–778.
Peluso MJ, Ferretti F, Peterson J, Lee E, Fuchs D, Boschini A, et al. Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load . AIDS 2012; 26:1765.
Mukerji SS, Misra V, Lorenz DR, Uno H, Morgello S, Franklin D, et al. Impact of antiretroviral regimens on cerebrospinal fluid viral escape in a prospective multicohort study of antiretroviral therapy-experienced human immunodeficiency virus-1-infected adults in the United States . Clin Infect Dis 2018; 67:1182–1190.
NHS Health Research Authority. Do I need NHS ethics approval? . 2020; http://www.hra-decisiontools.org.uk/ethics/http://www.hra-decisiontools.org.uk/ethics/ . [Accessed 28 January 2021].
Mukerji SS, Misra V, Lorenz D, Cervantes-Arslanian AM, Lyons J, Chalkias S, et al. Temporal patterns and drug resistance in CSF viral escape among ART-experienced HIV-1 infected adults . J Acquir Immune Defic Syndr 2017; 75:246–255.
Trunfio M, Pinnetti C, Focà E, Bai F, Maffongelli G, Celani L, et al. Cerebrospinal fluid HIV-1 escape according to different thresholds and underlying comorbidities: is it time to assess the definitions? . AIDS 2019; 33:759–762.
Imaz A, Cayuela N, Niubó J, Tiraboschi JM, Izquierdo C, Cabellos C, et al. Short communication: focal encephalitis related to viral escape and resistance emergence in cerebrospinal fluid in a patient on lopinavir/ritonavir monotherapy with plasma HIV-1 RNA suppression . AIDS Res Hum Retroviruses 2014; 30:984–987.
Martins J, Santos E, Salgado P, Maia L, Dias D, Marta M, et al. Recurrent cerebrospinal fluid escape in an HIV-1-infected patient receiving antiretroviral therapy . AIDS 2016; 30:1143–1144.
Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population . Clin Infect Dis 2011; 53:1120–1126.
Best BM, Letendre SL, Brigid E, Clifford DB, Collier AC, Gelman BB, et al. Low atazanavir concentrations in cerebrospinal fluid . AIDS 2009; 23:83–87.