title: Genetic composition of human immunodeficiency virus type 1 in cerebrospinal fluid and blood without treatment and during failing antiretroviral therapy.
abstract: Human immunodeficiency virus (HIV) infection of the central nervous system (CNS) is a significant cause of morbidity. The requirements for HIV adaptation to the CNS for neuropathogenesis and the value of CSF virus as a surrogate for virus activity in brain parenchyma are not well established. We studied 18 HIV-infected subjects, most with advanced immunodeficiency and some neurocognitive impairment but none with evidence of opportunistic infection or malignancy of the CNS. Clonal sequences of C2-V3 env and population sequences of pol from HIV RNA in cerebrospinal fluid (CSF) and plasma were correlated with clinical and virologic variables. Most (14 of 18) subjects had partitioning of C2-V3 sequences according to compartment, and 9 of 13 subjects with drug resistance exhibited discordant resistance patterns between the two compartments. Regression analyses identified three to seven positions in C2-V3 that discriminated CSF from plasma HIV. The presence of compartmental differences at one or more of the identified positions in C2-V3 was highly associated with the presence of discordant resistance (P = 0.007), reflecting the autonomous replication of HIV and the independent evolution of drug resistance in the CNS. Discordance of resistance was associated with severity of neurocognitive deficits (P = 0.07), while low nadir CD4 counts were linked both to the severity of neurocognitive deficits and to discordant resistance patterns (P = 0.05 and 0.09, respectively). These observations support the study of CSF HIV as an accessible surrogate for HIV virions in the brain, confirm the high frequency of discordant resistance in subjects with advanced disease in the absence of opportunistic infection or malignancy of the CNS, and begin to identify genetic patterns in HIV env associated with adaptation to the CNS.
authors.affiliation: University of California, San Diego, La Jolla, CA, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Strain
authors.forename: S
authors.initials: S
authors.lastname: Letendre
authors.forename: S K
authors.initials: SK
authors.lastname: Pillai
authors.forename: T
authors.initials: T
authors.lastname: Russell
authors.forename: C C
authors.initials: CC
authors.lastname: Ignacio
authors.forename: H F
authors.initials: HF
authors.lastname: Günthard
authors.forename: B
authors.initials: B
authors.lastname: Good
authors.forename: D M
authors.initials: DM
authors.lastname: Smith
authors.forename: S M
authors.initials: SM
authors.lastname: Wolinsky
authors.forename: M
authors.initials: M
authors.lastname: Furtado
authors.forename: J
authors.initials: J
authors.lastname: Marquie-Beck
authors.forename: J
authors.initials: J
authors.lastname: Durelle
authors.forename: I
authors.initials: I
authors.lastname: Grant
authors.forename: D D
authors.initials: DD
authors.lastname: Richman
authors.forename: T
authors.initials: T
authors.lastname: Marcotte
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
authors.forename: R J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: J K
authors.initials: JK
authors.lastname: Wong
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000821:virology; D000595:Amino Acid Sequence; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology*; D024882:Drug Resistance, Viral; D015686:Gene Products, env / Q000737:chemistry / Q000235:genetics*; D015684:Gene Products, pol / Q000737:chemistry / Q000235:genetics*; D015699:HIV Envelope Protein gp120 / Q000737:chemistry / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008969:Molecular Sequence Data; D009483:Neuropsychological Tests; D010446:Peptide Fragments / Q000737:chemistry / Q000235:genetics; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood*; D017422:Sequence Analysis, DNA; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents; D015686:Gene Products, env; D015684:Gene Products, pol; D015699:HIV Envelope Protein gp120; C059762:HIV envelope protein gp120 (305-321); D010446:Peptide Fragments; D012367:RNA, Viral