Motta Ilaria, Allice Tiziano, Romito Alessandra, Ferrara Micol, Ecclesia Sara, Imperiale Daniele, Ghisetti Valeria, Di Perri Giovanni, Bonora Stefano, Calcagno Andrea
Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy.
Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy.
Antivir Ther. 2017;22(6):539-543. doi: 10.3851/IMP3140. Epub 2017 Feb 15.
Cerebrospinal fluid (CSF) HIV RNA is commonly used as a marker of compartmental antiviral activity in HIV-positive patients. Undetectable CSF HIV RNA levels have been associated with low CSF neopterin levels and better neurocognitive performances. The aim of this study was to analyse the prevalence and predictors of non-detectable CSF HIV RNA using a commercial assay.
In adult HIV-positive HAART-treated patients with confirmed plasma HIV RNA <50 copies/ml, CSF HIV RNA (with Roche Amplicor Assay) and neopterin were measured.
112 adult patients were included. Plasma and CSF HIV RNA were non-detectable (target not detected [TND]) in 29 (25.9%) and 36 (32.1%) patients, respectively. CSF TND was observed more frequently in patients with plasma TND (P=0.005, OR=3.87). CSF neopterin levels were associated with age (rho =0.333, P=0.002) and current (rho= -0.272, P=0.015) and nadir (rho =-0.240, P=0.038) CD4 T-lymphocytes; the lowest CSF neopterin concentration was observed in patients with CSF TND versus other viral load strata (0.62 mg/dl versus 0.78 mg/dl; P=0.048).
Efficaciously treated HIV-positive patients with detectable plasma HIV RNA might imperfectly control CSF viral replication. Prospective studies addressing the management and neurocognitive consequences of CSF low-level viraemia are warranted.
脑脊液（CSF）HIV RNA通常用作HIV阳性患者局部抗病毒活性的标志物。脑脊液HIV RNA水平不可检测与脑脊液新蝶呤水平低及更好的神经认知表现相关。本研究的目的是使用一种商业检测方法分析脑脊液HIV RNA不可检测的患病率及预测因素。
对血浆HIV RNA经确认<50拷贝/ml的接受高效抗逆转录病毒治疗（HAART）的成年HIV阳性患者，检测脑脊液HIV RNA（采用罗氏Amplicor检测法）和新蝶呤。
纳入112例成年患者。血浆和脑脊液HIV RNA在29例（25.9%）和36例（32.1%）患者中不可检测（未检测到目标[TND]）。血浆TND患者中脑脊液TND更常见（P = 0.005，OR = 3.87）。脑脊液新蝶呤水平与年龄（rho = 0.333，P = 0.002）、当前（rho = -0.272，P = 0.015）及最低点（rho = -0.240，P = 0.038）CD4 T淋巴细胞相关；脑脊液TND患者与其他病毒载量分层患者相比，脑脊液新蝶呤浓度最低（0.62 mg/dl对0.78 mg/dl；P = 0.048）。
血浆HIV RNA可检测的经有效治疗的HIV阳性患者可能无法完美控制脑脊液病毒复制。有必要开展前瞻性研究探讨脑脊液低水平病毒血症的管理及神经认知后果。
