Trunfio Mattia, Rugge Walter, Mighetto Lorenzo, Vai Daniela, Atzori Cristiana, Nigra Marco, Domini Simone, Borgogno Enrica, Guastamacchia Giulia, Bonora Stefano, Di Perri Giovanni, Calcagno Andrea
Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Amedeo di Savoia Hospital, Torino.
Diagnostic Laboratory Unit.
AIDS. 2020 Nov 1;34(13):1899-1906. doi: 10.1097/QAD.0000000000002601.
Aim of this study was to compare cerebrospinal fluid (CSF) virological control, biomarkers and neurocognition of neurologically symptomatic patients on dual antiretroviral therapies (dual therapy) vs. 2 nucleoside reverse transcriptase inhibitors-based three-drug regimens (triple therapy).
Retrospective monocentric cross-sectional study.
We analysed data from people living with HIV undergoing lumbar puncture for clinical/research reasons with plasma HIV-RNA less than 200 copies/ml and neurological/neurocognitive symptoms without significant contributing comorbidities. We measured CSF HIV-RNA, inflammation, blood-brain barrier integrity, neuronal damage and astrocytosis biomarkers (five biomarkers by ELISA and five indices by immunoturbidimetry) and recorded the neurocognitive performance (14 tests). CSF escape was defined as any case of CSF HIV-RNA 0.5 Log10 higher than viraemia or any case of detectable CSF HIV-RNA coupled with undetectable viraemia.
A total of 78 patients on triple therapy and 19 on dual therapy were included. Overall, 75.3% male, median age 51 years (46-58), current CD4 count 545 cells/μl (349-735), time on current regimens 18 months (8-29), but length of plasma suppression 32 months (14-94). The two groups did not differ in terms of HIV-associated neurological diagnoses, demographic and viro-immunological features. Undetectable CSF HIV-RNA (73.7% in dual therapy vs. 78.2% in triple therapy, p.67) and CSF escape (21.1% in dual therapy vs. 19.2% in triple therapy, p.86) did not differ. No difference was observed in depression, anxiety, neurocognition (in 63 participants) nor in any tested biomarker.
In people living with HIV with neurological/neurocognitive symptoms, peripherally effective dual therapy can show CSF virosuppression, inflammation, neuronal and astrocyte integrity and neurocognition comparable to triple therapy.
本研究旨在比较接受双重抗逆转录病毒疗法（双药疗法）与基于两种核苷类逆转录酶抑制剂的三药方案（三联疗法）的有神经系统症状患者的脑脊液（CSF）病毒学控制、生物标志物和神经认知情况。
回顾性单中心横断面研究。
我们分析了因临床/研究原因接受腰椎穿刺的HIV感染者的数据，这些患者血浆HIV-RNA低于200拷贝/毫升，有神经系统/神经认知症状且无显著合并症。我们测量了脑脊液HIV-RNA、炎症、血脑屏障完整性、神经元损伤和星形细胞增多症生物标志物（通过酶联免疫吸附测定法检测5种生物标志物，通过免疫比浊法检测5项指标），并记录神经认知表现（14项测试）。脑脊液逃逸定义为脑脊液HIV-RNA比病毒血症高0.5 Log10的任何情况，或脑脊液HIV-RNA可检测而病毒血症不可检测的任何情况。
共纳入78例接受三联疗法的患者和19例接受双药疗法的患者。总体而言，75.3%为男性，中位年龄51岁（46 - 58岁），当前CD4细胞计数为545个/微升（349 - 735），当前治疗方案的时间为18个月（8 - 29个月），但血浆抑制时间为32个月（14 - 94个月）。两组在HIV相关神经系统诊断、人口统计学和病毒免疫特征方面无差异。脑脊液HIV-RNA不可检测（双药疗法中为73.7%，三联疗法中为78.2%，p = 0.67）和脑脊液逃逸（双药疗法中为21.1%，三联疗法中为19.2%，p = 0.86）无差异。在抑郁、焦虑、神经认知（63名参与者）或任何检测的生物标志物方面均未观察到差异。
在有神经系统/神经认知症状的HIV感染者中，外周有效的双药疗法在脑脊液病毒抑制、炎症、神经元和星形细胞完整性以及神经认知方面可与三联疗法相媲美。
