Cerebrospinal fluid HIV-1 escape in patients with neurocognitive symptoms: pooled data from a neuro-HIV platform and the NAMACO study.

Filippidis, Paraskevas; Damas, Jose; Viala, Benjamin; Assal, Frederic; Tshikung, Olivier Nawej; Tarr, Philip; Derfuss, Tobias; Oberholzer, Michael; Jelcic, Ilijas; Hundsberger, Thomas; Sacco, Leonardo; Cavassini, Matthias; Du Pasquier, Renaud; Darling, Katharine E A (2023). Cerebrospinal fluid HIV-1 escape in patients with neurocognitive symptoms: pooled data from a neuro-HIV platform and the NAMACO study. Journal of acquired immune deficiency syndromes, 93(3), pp. 219-228. Wolters Kluwer Health 10.1097/QAI.0000000000003189

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BACKGROUND

Despite modern antiretroviral therapy, HIV-1 RNA escape into the cerebrospinal fluid (CSF) may occur. We examined the prevalence of and factors associated with CSF HIV-1 escape among people living with HIV (PLWH) in Switzerland.

SETTING

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is an ongoing, prospective, longitudinal, multicenter study within the Swiss HIV Cohort Study. The neuro-HIV platform is a multi-disciplinary, single-day outpatient consultation at Lausanne University Hospital.

METHODS

We pooled data from the NAMACO study and the neuro-HIV platform participants who underwent lumbar puncture (LP) between 2011 and 2019. Both patient groups had neurocognitive symptoms. CSF HIV-1 escape was defined as the presence of quantifiable CSF HIV-1 RNA when plasma HIV-1 RNA was suppressed or CSF HIV-1 RNA greater than plasma HIV-1 RNA when the latter was detectable.

RESULTS

Of 1166 PLWH assessed, 288 underwent LP. CSF HIV-1 escape was observed in 25 PLWH (8.7%) of whom 19 (76%) had supressed plasma HIV-1 RNA. Characteristics of PLWH were comparable whether they had CSF HIV-1 escape or not, including comorbidities, time since HIV diagnosis (15 vs 16 years, p=0.9), median CD4 nadir (158.5/mm3 vs 171/mm3, p=0.6), antiretroviral CSF-Penetration-Effectiveness score (7 vs 7 points, p=0.8), neurocognitive diagnosis based on Frascati criteria and radiological findings.

CONCLUSIONS

In this large pooled sample of PLWH with neurocognitive symptoms, CSF HIV-1 escape occurred in 8.7% of PLWH. PLWH with CSF HIV-1 escape presented no distinctive clinical or paraclinical characteristics. We conclude that LP is unavoidable in confirming CSF HIV-1 escape.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Oberholzer, Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1944-7884

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Pubmed Import

Date Deposited:

20 Mar 2023 13:44

Last Modified:

13 Jun 2023 00:13

Publisher DOI:

10.1097/QAI.0000000000003189

PubMed ID:

36927958

BORIS DOI:

10.48350/180303

URI:

https://boris.unibe.ch/id/eprint/180303

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