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

Artikel i vetenskaplig tidskrift
Författare Aylin Yilmaz
Chris Verhofstede
Antonio Dʼavolio
Victoria Watson
Lars Hagberg
Dietmar Fuchs
Bo Svennerholm
Magnus Gisslén
Publicerad i Journal of acquired immune deficiency syndromes (1999)
Volym 55
Nummer/häfte 5
Sidor 590-596
ISSN 1944-7884
Publiceringsår 2010
Publicerad vid Institutionen för biomedicin, avdelningen för infektionssjukdomar
Sidor 590-596
Språk en
Länkar dx.doi.org/10.1097/QAI.0b013e3181f5...
Ämnesord antiretroviral drug intensification, cerebrospinal fluid, HIV RNA, viral reservoir
Ämneskategorier Infektionsmedicin

Sammanfattning

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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