Relapse of Symptomatic Cerebrospinal Fluid HIV Escape
- PDF / 784,753 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 12 Downloads / 213 Views
CENTRAL NERVOUS SYSTEM AND COGNITION (SS SPUDICH, SECTION EDITOR)
Relapse of Symptomatic Cerebrospinal Fluid HIV Escape Francesca Ferretti 1,2 & Valentina De Zan 1 & Simonetta Gerevini 3,4 & Filippo Turrini 1 & Enzo Boeri 5 & Nicola Gianotti 1 & Hamid Hasson 1 & Adriano Lazzarin 1 & Paola Cinque 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Symptomatic cerebrospinal fluid (CSF) HIV escape defines the presence of neurological disease in combination antiretroviral therapy (cART)-treated persons due to HIV replication in CSF despite systemic suppression or to higher viral replication in CSF than in plasma. The aim was to search for cases of recurrent symptomatic CSF escape and to define their characteristics. Recent Findings By review of the literature, we identified symptomatic CSF escape relapses in three patients who had shown clinical remission of a first escape episode following cART optimization. By examination of our cohort of 21 patients with symptomatic CSF escape, we identified five additional patients. In the latter, viral escape relapsed over a median follow-up of 108 months because of low adherence or upon treatment simplification of a previously optimized regimen. cART reoptimization based on resistance profile and potential drug neuropenetration and efficacy led to relapse resolution with no further episodes after a median follow-up of 50 months from relapse. Summary The observation that CSF escape may relapse highlights the importance of long-term neuro-suppressive regimens after a first episode and supports the role of the brain as a reservoir for HIV. Keywords HIV . Antiretroviral treatment . Cerebrospinal fluid . Viral escape . Central nervous system . Reservoir
Introduction In HIV-infected patients receiving effective combination antiretroviral treatment (cART), discordant HIV replication
between cerebrospinal fluid (CSF) and plasma can be associated with neurological symptoms and white matter changes on magnetic resonance imaging (MRI), the so-called neurosymptomatic CSF viral escape [1•]. Formally, CSF escape
This article is part of the Topical Collection on Central Nervous System and Cognition * Paola Cinque [email protected]
Hamid Hasson [email protected]
Francesca Ferretti [email protected] Valentina De Zan [email protected]
Adriano Lazzarin [email protected] 1
Department of Infectious Diseases, San Raffaele Scientific Institute and San Raffaele Vita-Salute University, Via Stamira d’Ancona 20, 20127 Milan, Italy
2
Present address: Chelsea and Westminster Hospital NHS Trust, London, UK
3
Unit of Neuroradiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
Enzo Boeri [email protected]
4
Present address: Unit of Neuroradiology, Ospedali Riuniti, Bergamo, Italy
Nicola Gianotti [email protected]
5
Laboratory of Microbiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
Simonetta Gerevini [email protected] Filippo Turrini [email protected]
Data Loading...
