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Cerebrospinal Fluid HIV Escape from Antiretroviral Therapy

Journal article
Authors F. Ferretti
Magnus Gisslén
P. Cinque
R. W. Price
Published in Current Hiv/Aids Reports
Volume 12
Issue 2
Pages 280-288
ISSN 1548-3568
Publication year 2015
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 280-288
Language en
Links dx.doi.org/10.1007/s11904-015-0267-...
Keywords HIV, Cerebrospinal fluid (CSF), Central nervous system (CNS), Brain, Treatment, Encephalitis, HUMAN-IMMUNODEFICIENCY-VIRUS, CENTRAL-NERVOUS-SYSTEM, PROTEASE INHIBITOR, MONOTHERAPY, VIRAL ESCAPE, TRANSENDOTHELIAL MIGRATION, ACUTE, MENINGOENCEPHALITIS, NEUROLOGICAL SYMPTOMS, TYPE-1 INFECTION, AIDS, PATIENTS, RNA LEVELS, Infectious Diseases
Subject categories Infectious Medicine

Abstract

CNS infection is a nearly constant facet of systemic CNS infection and is generally well controlled by suppressive systemic antiretroviral therapy (ART). However, there are instances when HIV can be detected in the cerebrospinal fluid (CSF) despite suppression of plasma viruses below the clinical limits of measurement. We review three types of CSF viral escape: asymptomatic, neuro-symptomatic, and secondary. The first, asymptomatic CSF escape, is seemingly benign and characterized by lack of discernable neurological deterioration or subsequent CNS disease progression. Neuro-symptomatic CSF escape is an uncommon, but important, entity characterized by new or progressive CNS disease that is critical to recognize clinically because of its management implications. Finally, secondary CSF escape, which may be even more uncommon, is defined by an increase of CSF HIV replication in association with a concomitant non-HIV infection, as a consequence of the local inflammatory response. Understanding these CSF escape settings not only is important for clinical diagnosis and management but also may provide insight into the CNS HIV reservoir.

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