Clinical implications of HIV-1 drug resistance in the neurological compartment.
The tropism of human immunodeficiency virus type 1 (HIV-1) for the central nervous system (CNS) develops early during the course of the infection. Potent antiretroviral therapy has been demonstrated to be effective in controlling the replication of HIV-1 in cerebrospinal fluid (CSF), even though a variable response in this compartment compared with that in plasma has been observed. Different concentrations of antiretroviral drugs are found in CSF and the use of antiretroviral drugs penetrating across the blood-brain barrier is considered to be required for controlling CNS infection in advanced patients, particularly in those with neurological disorders. The compartmentalization of HIV-1 infection in the CNS may affect the treatment response, which may cause a different evolution of viral drug resistance in the 2 compartments. Although HIV-1 resistance testing in CSF is not recommended for the routine management of patients with virological failure, treatment decisions in patients with neurological disorders may require knowledge of the resistance profile of the virus in the CSF.
Antinori
Andrea
A
National Institute for Infectious Diseases 'Lazzaro Spallanzani', IRCCS, Rome, Italy.
Cingolani
Antonella
A
Giancola
Maria Letizia
ML
Forbici
Federica
F
De Luca
Andrea
A
Perno
Carlo Federico
CF
D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001682:Biological Availability; D001812:Blood-Brain Barrier; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D015497:HIV-1 / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012367:RNA, Viral; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D019562:Viral Load; D014779:Virus Replication / Q000187:drug effects*
D019380:Anti-HIV Agents; D012367:RNA, Viral