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Treatment Intensification Has no Effect on the HIV-1 Central Nervous System Infection in Patients on Suppressive Antiretroviral Therapy.

Journal article
Authors Aylin Yilmaz
Chris Verhofstede
Antonio Dʼavolio
Victoria Watson
Lars Hagberg
Dietmar Fuchs
Bo Svennerholm
Magnus Gisslén
Published in Journal of acquired immune deficiency syndromes (1999)
Volume 55
Issue 5
Pages 590-596
ISSN 1944-7884
Publication year 2010
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 590-596
Language en
Links dx.doi.org/10.1097/QAI.0b013e3181f5...
Keywords antiretroviral drug intensification, cerebrospinal fluid, HIV RNA, viral reservoir
Subject categories Infectious Medicine

Abstract

BACKGROUND:: Antiretroviral treatment (ART) significantly reduces cerebrospinal fluid (CSF) HIV-1 RNA levels and residual viremia is less frequently found in CSF than in blood. However, persistent intrathecal immunoactivation is common, even after several years of ART. To investigate whether low-level CSF viremia and residual immunoactivation within the central nervous system (CNS) derive from ongoing local viral replication, we conducted a study of treatment intensification in patients on effective ART. METHODS:: Ten patients on ART with plasma HIV RNA <50 copies per milliliter for >18 months were included. Intensification was given for in total 8 weeks: 4 weeks with maraviroc or lopinavir/ritonavir (good CNS penetration), and 4 weeks with enfuvirtide (poor CNS penetration). Lumbar punctures were performed 4 weeks before, at intensification commencement, at switchover after 4 weeks, at the conclusion of, and 4 weeks after the intensification period. RESULTS:: No significant changes in HIV RNA, neopterin, β2-microglobulin, immunoglobulin G index, albumin ratio, and CD4 T-cell count were observed, either in CSF or blood, neither before, during, nor after the intensification periods. CONCLUSIONS:: ART intensification did not reduce residual CSF HIV RNA levels or intrathecal immunoactivation in patients on ART. These findings do not support an ongoing viral replication in CNS.

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