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Abstract
: Cerebrospinal fluid (CSF) viral escape is defined by detectable HIV-RNA in CSF despite undetectable or lower-than-CSF level in plasma of patients receiving combination antiretroviral therapy (cART). This condition may occasionally be associated with neurological problems, consisting of new and progressive cognitive decline and/or focal symptoms and signs, defining the 'symptomatic CSF escape'. Brain MRI usually shows diffuse white matter hyperintensities that recall the presentation of HIV encephalopathy in the precART era. However, patients develop symptomatic CSF escape with relatively high CD4 cell counts and suppressed or low systemic virus replication. In addition, the frequent CSF pleocytosis and the pathological demonstration of CD8 T-cell brain infiltrates in some cases of symptomatic escape indicate that inflammation is an important component in the pathogenesis of this condition. Low nadir CD4 cells are common, likely reflecting the establishment of a HIV reservoir in the central nervous system (CNS). CSF escape seems to result from reactivation of CNS infection when cART potency is lowered, because of low patient's adherence, drug resistance, or use of drug combinations that are poorly effective in the CNS and cART optimization is key to revert escape and neurological disease in the great majority of cases.
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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. [PMID: 28328546 PMCID: PMC5452976 DOI: 10.1097/qai.0000000000001362] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Cerebrospinal fluid (CSF) viral escape is an increasingly recognized clinical event among HIV-1-infected adults. We analyzed longitudinal data and drug-resistance mutations to characterize profiles of HIV-1-infected patients on antiretroviral therapy with discordant CSF and plasma HIV-1 RNA levels. Methods: Forty-one cases of CSF escape defined as detectable CSF HIV-1 RNA when plasma levels were undetectable, or HIV-1 RNA >0.5-log higher in CSF than plasma were identified from Boston Hospitals and National NeuroAIDS Tissue Consortium (NNTC) from 2005 to 2016. Results: Estimated prevalence of CSF escape in Boston and NNTC cohorts was 6.0% and 6.8%, respectively; median age was 50, duration of HIV-1 infection 17 years, CD4 count 329 cells/mm3 and CD4 nadir 21 cells/mm3. Neurological symptoms were present in 30 cases; 4 had repeat episodes of CSF escape. Cases were classified into subtypes based plasma HIV-1 RNA levels in the preceding 24 months: high-level viremia (1000 copies/mL), low-level viremia (LLV: 51–999 copies/mL), and plasma suppression with CSF blip or escape (CSF RNA <200 or ≥200 copies/mL). High-level viremia cases reported more substance abuse, whereas LLV or plasma suppression cases were more neurosymptomatic (81% vs. 53%); 75% of repeat CSF escape cases were classified LLV. M184V/I mutations were identified in 74% of CSF samples when plasma levels were ≤50 copies per milliliter. Conclusions: Characteristics frequently observed in CSF escape include HIV-1 infection >15 years, previous LLV, and M184V/I mutations in CSF. Classification based on preceding plasma HIV RNA levels provides a useful conceptual framework to identify causal factors and test therapeutics.
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Soulie C, Descamps D, Grudé M, Schneider V, Trabaud MA, Morand-Joubert L, Delaugerre C, Montes B, Barin F, Ferre V, Raymond S, Jeulin H, Alloui C, Yerly S, Pallier C, Reigadas S, Signori-Schmuck A, Guigon A, Fafi-Kremer S, Haïm-Boukobza S, Mirand A, Maillard A, Vallet S, Roussel C, Assoumou L, Calvez V, Flandre P, Marcelin AG. Antiretroviral-naive and -treated HIV-1 patients can harbour more resistant viruses in CSF than in plasma. J Antimicrob Chemother 2014; 70:566-72. [PMID: 25344810 DOI: 10.1093/jac/dku419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The neurological disorders in HIV-1-infected patients remain prevalent. The HIV-1 resistance in plasma and CSF was compared in patients with neurological disorders in a multicentre study. METHODS Blood and CSF samples were collected at time of neurological disorders for 244 patients. The viral loads were >50 copies/mL in both compartments and bulk genotypic tests were realized. RESULTS On 244 patients, 89 and 155 were antiretroviral (ARV) naive and ARV treated, respectively. In ARV-naive patients, detection of mutations in CSF and not in plasma were reported for the reverse transcriptase (RT) gene in 2/89 patients (2.2%) and for the protease gene in 1/89 patients (1.1%). In ARV-treated patients, 19/152 (12.5%) patients had HIV-1 mutations only in the CSF for the RT gene and 30/151 (19.8%) for the protease gene. Two mutations appeared statistically more prevalent in the CSF than in plasma: M41L (P=0.0455) and T215Y (P=0.0455). CONCLUSIONS In most cases, resistance mutations were present and similar in both studied compartments. However, in 3.4% of ARV-naive and 8.8% of ARV-treated patients, the virus was more resistant in CSF than in plasma. These results support the need for genotypic resistance testing when lumbar puncture is performed.
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Affiliation(s)
- Cathia Soulie
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, F-75013 Paris, France
| | - Diane Descamps
- IAME, UMR 1137-Université Paris Diderot, Sorbonne Paris Cité, INSERM, F-75018 Paris, France AP-HP, Hôpital Bichat, Laboratoire de Virologie, F-75018 Paris, France
| | - Maxime Grudé
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France
| | | | | | - Laurence Morand-Joubert
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France Laboratoire de Virologie, AP-HP, CHU Saint Antoine, Paris, France
| | - Constance Delaugerre
- INSERM U941-Université Paris Diderot, Sorbonne Paris Cité, INSERM F-75010 Paris, France AP-HP, Hôpital Saint-Louis, Laboratoire de Virologie, F-75010 Paris, France
| | | | | | | | | | - Hélène Jeulin
- Laboratoire de Virologie, CHU de Nancy Brabois, Vandoeuvre les Nancy, France EA 7300, Université de Lorraine, Faculté de Médecine, Vandoeuvre les Nancy, France
| | | | - Sabine Yerly
- Laboratory of Virology, Geneva University Hospitals, Switzerland
| | | | - Sandrine Reigadas
- CHU de Bordeaux, Laboratoire de Virologie, F-33000 Bordeaux, France Université de Bordeaux, CNRS UMR 5234, F-33000 Bordeaux, France
| | | | | | | | - Stéphanie Haïm-Boukobza
- CHU Paul Brousse, Laboratoire de Virologie, Villejuif, France INSERM U795, Univ Paris Sud, Hepatinov, Villejuif, France
| | | | | | | | | | - Lambert Assoumou
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France
| | - Vincent Calvez
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, F-75013 Paris, France
| | - Philippe Flandre
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Universités, UPMC Université de Paris, 06-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75005 Paris, France INSERM-UMR_S 1136 Pierre Louis Institute of Epidemiology and Public Health, F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, F-75013 Paris, France
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