Cerebrospinal fluid HIV-1 infection usually responds well to antiretroviral treatment.
The primary objective of this retrospective study was to determine how many patients in routine practice who were treated with combination antiretroviral treatment reached HIV-1 RNA levels below 50-400 copies/ml in cerebrospinal fluid (CSF). Seventy-four antiretroviral-naive HIV-1-infected patients from five different centres in Germany, Italy, Sweden and the USA were included. Thirty-nine percent of the patients had a HIV-1-associated neurological disease and 53% of the patients had AIDS. HIV-1 RNA in CSF and plasma were quantified before and after approximately 3 months of treatment. At baseline, the median value of HIV-1 RNA in CSF was 4.12 log copies/ml (interquartile range (IQR): 3.28-4.85) and it decreased to < 1.70 log copies/ml (IQR: < 1.70-2.48; P < 0.001) after in median 3 months of treatment. Seventy-six percent of the patients had HIV-1 RNA levels below the limits of detection in CSF at follow-up, and 85% reached below 400 copies/ml. In plasma, 45% of the patients had levels of HIV-1 RNA below the limits of detection at follow-up and 80% reached below 400 copies/ml. The group of patients with a neurological disease had a significantly higher CSF viral load both at baseline and at follow-up compared with the neurologically asymptomatic patients. We conclude that the central nervous system (CNS) is usually not a 'sanctuary site', difficult to reach with combination antiretroviral treatment.
Mellgren
Asa
A
Department of Infectious Diseases, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden asa_mellgren@yahoo.com
Antinori
Andrea
A
Cinque
Paola
P
Price
Richard W
RW
Eggers
Christian
C
Hagberg
Lars
L
Gisslén
Magnus
M
D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000821:virology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid*; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors