Rita PatrocÃÂnio-Jesus, BÃÂ¡rbara Flor-De-Lima, Casimiro Carlos, Joana Batis ta, Trigo Diva, Joana Silva, Pacheco PatrÃÂcia
Introduction: Combination antiretroviral therapy (cART) effectively reduces HIV replication in plasma and cerebrospinal fluid. CSF HIV escape is defined by viral replication in CNS despite virologic suppression in plasma or by higher viral load in CSF than in plasma. The aim of this study was to characterize the patients who met criteria of CNS HIV escape during a 4-year period in a Portuguese hospital.
Methods: Retrospective cohort study of adult patients with chronic HIV-1 infection with detectable CSF HIV viral load meeting criteria for CNS HIV escape (n=12), from November 2014 to September 2018.
Results: Twelve patients were identified, who presented with long-term HIV infection and low nadir CD4+ T-cell count, and had been on cART for a mean duration of 6 years. Current regimen included in most two NRTIs (n=11) and PI (n=10). Most patients presented with recent onset neuropsychiatric symptoms. Mean CD4+ T-cell count at the time of viral escape was 361 cells/μL and median viral load in plasma and CSF was respectively 40 copies/mL and 550 copies/mL. Nine patients (75%) had low level viremia in peripheral blood (20-500 copies/mL) in the previous 6 months. Three patients presented concomitant CNS infections (EBV (n=2) and syphilis (n=1)). All patients who had available genotype resistance tests for CSF HIV RNA (n=4) revealed new resistance-associated mutations (M184V (n=3) or Y115F and K65R (n=1)). In 11 patients cART was modified, achieving clinical improvement.
Conclusion: The diagnosis of CNS HIV viral escape should be considered in patients on cART who experience neurological or psychiatric symptoms.