Cerebrospinal fluid HIV-1 escape in patients with neurocognitive symptoms: Pooled data from a neuro-HIV platform and the NAMACO Study. JAIDS
Filippidis et al. for the NAMACO study group aimed to evaluate the prevalence of cerebrospinal fluid (CSF) HIV-1 escape among people living with HIV (PLWH) in Switzerland and to identify potential predictive factors and clinical characteristics associated with this phenomenon.
The study group pooled data from the Neurocognitive Assessment in the Metabolic and Aging Cohort study and the neuro-HIV platform participants who underwent lumbar puncture between 2011 and 2019. Both patient groups had neurocognitive symptoms. Cerebrospinal fluid HIV-1 escape was defined as the presence of quantifiable CSF HIV-1 RNA when plasma HIV-1 RNA was suppressed or CSF HIV-1 RNA greater than plasma HIV-1 RNA when the latter was detectable.
Of 1’166 PLWH assessed, 288 underwent lumbar puncture. Cerebrospinal fluid HIV-1 escape was observed in 25 PLWH (8.7%) of whom 19 (76%) had suppressed plasma HIV-1 RNA. Characteristics of PLWH were comparable whether they had CSF HIV-1 escape or not, including comorbidities, time since HIV diagnosis (15 vs 16 years, P = 0.9), median CD4 nadir (158.5/mm3 vs 171/mm3, P = 0.6), antiretroviral CSF penetration-effectiveness score (7 vs 7 points, P = 0.8), and neurocognitive diagnosis based on Frascati criteria and radiological findings.
In conclusion, this study observed CSF HIV-1 escape in 8.7% of patients with suspected or confirmed neurocognitive impairment (NCI) in a large case series. Importantly, three-quarters of the patients with CSF HIV-1 escape had undetectable plasma viral loads. With the exception of detectable plasma HIV-1 RNA, the study found no reliable demographic, clinical, immunological, neurocognitive, or radiological predictive factor for CSF HIV-1 escape. Hence, the authors conclude that lumbar puncture is the only means to detect CSF HIV-1 escape, and should be considered in all patients presenting NCI, especially in the absence of other factors not directly linked to HIV, because the identification of CSF HIV-1 escape through LP may prompt ART modification.