Prevalence and correlates of persistent HIV-1 RNA in cerebrospinal fluid during antiretroviral therapy

AM Anderson, JA Muņoz-Moreno… - The Journal of …, 2016 - academic.oup.com
AM Anderson, JA Muņoz-Moreno, D McClernon, RJ Ellis, D Cookson, DB Clifford, AC Collier…
The Journal of infectious diseases, 2016academic.oup.com
Background Neurocognitive disorders remain common among HIV+ adults, perhaps due to
persistent HIV-1 RNA in cerebrospinal fluid (CSF) during antiretroviral therapy (ART).
Methods Using a single copy assay, we measured HIV-1 RNA in CSF and plasma from 220
HIV+ adults who were taking suppressive ART. Fifty-five participants were tested twice.
Results HIV-1 RNA was detected in 42.3% of CSF and 65.2% of plasma samples. Correlates
of higher CSF HIV-1 RNA included higher nadir and current CD4+ counts, plasma HIV-1 …
Background
Neurocognitive disorders remain common among HIV+ adults, perhaps due to persistent HIV-1 RNA in cerebrospinal fluid (CSF) during antiretroviral therapy (ART).
Methods
Using a single copy assay, we measured HIV-1 RNA in CSF and plasma from 220 HIV+ adults who were taking suppressive ART. Fifty-five participants were tested twice.
Results
HIV-1 RNA was detected in 42.3% of CSF and 65.2% of plasma samples. Correlates of higher CSF HIV-1 RNA included higher nadir and current CD4+ counts, plasma HIV-1 RNA≥1 c/mL, and lower CPE values (Model p<0.001). Worse neurocognitive (NC) performance was associated with the HIV-1 RNA discordance, lower overall CSF HIV-1 RNA, and longer ART duration among others (Model p<0.001). In the longitudinal subgroup, CSF HIV-1 RNA persisted in most (69%) participants over 7 months.
Conclusions
Low-level HIV-1 RNA in CSF is common during suppressive ART and is associated with low-level HIV-1 RNA in blood, better immune status, and lower ART drug distribution into CSF. The association between HIV-1 RNA discordance and HAND may reflect compartmentalization. The relationship between HAND, lower HIV-1 RNA in CSF, and lower CD4+ counts may reflect disturbances in the immune response to HIV-1 in the CNS.
Oxford University Press