Viro-immunological characterization of naïve patients with high cerebrospinal fluid (CSF) HIV RNA.
BACKGROUND
HIV can spread into the central nervous system (CNS) early in the course of infection and this turns into intrathecal inflammation and neuronal damage. We aimed to investigate clinical and immunological parameters associated with elevated CSF VL in HIV-infected ART-naïve patients.


METHODS
HIV+ ART-naïve patients underwent a comprehensive battery of neurocognitive (NC) tests and lumbar puncture (LP) for CSF HIV-RNA detection. Plasma HIV-RNA and peripheral T-cell immune-phenotypes (CD38/CD45RA/CD45R0/CD127 on CD4/CD8) were also assessed (flow cytometry). High-CSF HIV RNA was defined as≥10000cp/mL (H-CSF), while CSF HIV RNA<10000cp/mL characterized low VL patients (L-CSF). Chi-square and Mann-Whitney tests were used. Parameters independently associated with CSF VL were explored by multivariate regression.


RESULTS
A total of 131 patients were retrospectively enrolled. Forty-two patients (32%) had CSF VL >10000 cp/mL.


CONCLUSIONS
We hereby describe a 32% prevalence of H-CSF in a cohort of HIV+ ART-naïve patients. Subjects with high-CSF viral replication are mostly with higher systemic immune activation, in particular the percentage of naïve CD8 T-cell is positively associated with CSF VL, irrespective of plasma VL. In HIV+ ART-naïve patients, especially if featuring a hyperactivated T-cell immune-phenotype, lumbar puncture should be considered to further guide CNS-targeted cART.
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Francesca
F
Iannuzzi
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Francesca
F
Bai
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Esther
E
Merlini
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Mattia
M
Trunfio
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Lidia
L
Borghi
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Teresa
T
Bini
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Antonella d'Arminio
Ad
Monforte
Clinical of Infectious Disease, San Paolo Hospital, University of Milan, Milan, Italy.
Giulia Marchetti
GM
Carla