Minimal detection of cerebrospinal fluid escape after initiation of antiretroviral therapy in acute HIV-1 infection
Year: 2020
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Despite suppression of HIV-1 replication in the periphery by antiretroviral therapy (ART), up to 10% of treated individuals have quantifiable HIV-1 in the CSF, termed CSF escape. CSF escape may be asymptomatic but has also been linked to progressive neurological disease, and may indicate persistence of HIV in the central nervous system (CNS). CSF escape has not yet been assessed after initiation of ART during acute HIV-1 infection (AHI). DESIGN: Prospective cohort study. SETTING: Major voluntary counseling and testing site in Bangkok, Thailand. PARTICIPANTS: Participants identified and initiated on ART during AHI who received an optional study lumbar puncture at pre-ART baseline or after 24 or 96 weeks of ART. MAIN OUTCOME MEASURES: Paired levels of CSF and plasma HIV-1 RNA, with CSF greater than plasma HIV-1 RNA defined as CSF escape. RESULTS: Two hundred and four participants had paired blood and CSF sampling in at least one visit at baseline, week 24, or week 96. Twenty-nine participants had CSF sampling at all three visits. CSF escape was detected in 1/90 at week 24 (CSF HIV-1 RNA 2.50 log10 copies/ml, plasma HIV-1 RNA <50 copies/ml), and 0/55 at week 96. CONCLUSION: Although levels of CSF HIV-1 RNA in untreated AHI are high, initiating treatment during AHI results in a very low rate of CSF escape in the first 2 years of treatment. Early treatment may improve control of HIV-1 within the CNS compared with treatment during chronic infection, which may have implications for long-term neurological outcomes and CNS HIV-1 persistence.
Source: AIDS
Institutions: Yale University, Thai Red Cross Society, Walter Reed Army Institute of Research, Henry M. Jackson Foundation, HIV Netherlands Australia Thailand Research Collaboration, Chulalongkorn University, University of Missouri–St. Louis, Missouri Institute of Mental Health, University of California, San Francisco, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, University of Amsterdam
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
Funders: U.S. Department of Defense, Henry M. Jackson Foundation, Yale University, University of Minnesota, Case Western Reserve University, RTI International, Drexel University, Chulalongkorn University, National Institutes of Health, University of California, San Francisco, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Cancer Institute, National Institute of Neurological Disorders and Stroke, National Center for Advancing Translational Sciences
Awards: Therapeutic Interventions during Acute Infection to Address the CNS Reservoir for, ADDRESSING THE THREATS OF HIV AND EMERGING INFECTIOUS DISEASE TO THE MILITARY AND GLOBAL COMMUNITY THROUGH INNOVATIVE RESEARCH, Critical Role of Cytotoxic T Cells in HIV Neuropathogenesis, G2623559198, Long-Term CNS Consequences of Treatment During Acute Infection, G3818830583, G4119534169, G4180294558, G5850682332, G633733221, G8093122957, G8166743225, Short Term Research Training: Students in Health Professional Schools, Yale Clinical and Translational Science Award, G914732075
OpenAlex ID: W3112784825