title: Factors associated with cerebrospinal fluid HIV RNA in HIV infected subjects undergoing lumbar puncture examination in a clinical setting.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) HIV RNA load may be associated with central nervous system (CNS) disease in HIV infected subjects. We investigated parameters associated with CSF HIV RNA within a large clinical cohort.
  
  
  METHODS
  All HIV infected subjects undergoing CSF examination including assessment of CSF HIV RNA at St. Mary's Hospital, London, UK between January 2008 and October 2010 were included. Parameters associated with a detectable CSF HIV RNA load were assessed using linear regression modelling. CSF viral escape was defined as CSF RNA >0.5 log(10) copies/mL greater than plasma HIV RNA and >200 copies/mL where plasma HIV RNA <50 copies/mL.
  
  
  RESULTS
  Of 142 subjects, 99 were receiving antiretroviral therapy (ART). Plasma HIV RNA was <50 copies/mL in 69 subjects. CSF examination was performed for investigation of presumed HIV encephalopathy (IxHE, n = 57), other CNS diseases considered HIV related (n = 39), syphilis (n = 20) and CNS presentations not considered HIV related (n = 26). CSF viral escape was present in 30/142 (21%) subjects overall and in 9/69 (13%) of those on ART with undetectable plasma HIV RNA. Overall, plasma HIV RNA load was significantly associated with detectable CSF HIV RNA (p ≤ 0.001). In subjects with plasma HIV RNA <50 copies/mL, only CNS penetration effectiveness (CPE, 2008) score of <2 was significantly associated with detectable CSF HIV RNA (p = 0.044). In patients undergoing LP for IxHE both plasma HIV RNA and CPE scores were independently associated with detectable CSF HIV RNA (p = 0.019 & 0.003 respectively) which was not observed in subjects undergoing CSF examination for other medical reasons.
  
  
  CONCLUSIONS
  In a clinical setting, CSF viral escape is observed frequently in 21% of subjects and is associated with different parameters depending on the clinical scenario.
authors.affiliation: Department of Medicine, Faculty of Medicine, Imperial College London, St. Mary's Hospital Campus, Norfolk Place, London W2 1PG, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Rawson
authors.forename: David
authors.initials: D
authors.lastname: Muir
authors.forename: Nicola E
authors.initials: NE
authors.lastname: Mackie
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Garvey
authors.forename: Alex
authors.initials: A
authors.lastname: Everitt
authors.forename: Alan
authors.initials: A
authors.lastname: Winston
mesh_terms: D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000821:virology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D012367:RNA, Viral / Q000134:cerebrospinal fluid*; D012044:Regression Analysis; D013129:Spinal Puncture; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral