Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA.
Department of Psychiatry, University of California, San Diego, CA.
J Acquir Immune Defic Syndr. 2021 Aug 15;87(5):1196-1204. doi: 10.1097/QAI.0000000000002714.
Cognitive complications persist in persons with HIV during suppressive antiretroviral therapy (ART). Low levels of HIV during ART could contribute to these complications. In this study, we measured cerebrospinal fluid (CSF) HIV using a single-copy assay (SCA) to investigate a possible relationship between low-level HIV and cognition.
DESIGN/METHODS: SCA data were analyzed from 3 consecutively paired CSF-plasma specimens collected over a mean of 456 days from 96 participants on suppressive ART. Using mixed models, the presence of CSF HIV by SCA as a risk factor for worse neurocognitive performance was examined.
At baseline on the SCA, 45.8% of participants had detectable plasma HIV RNA (median 8 copies/mL and interquartile range = 3-17 among detectable values) and 17.7% had detectable CSF HIV RNA (median CSF concentration= 3 copies/mL and interquartile range= 2-13 among detectable values). The frequency of CSF HIV RNA detection declined over time in CSF (P = 0.018) with a trend toward decline in plasma (P = 0.064). Detectable CSF HIV RNA during the study was associated with worse performance in the domains of recall (P = 0.014) and motor (P = 0.040) and a trend with worse overall global performance (P = 0.078). Integrase inhibitor use, although very infrequent in this cohort, was associated with better performance in 2 domains.
Low-level CSF HIV RNA declines with time but is associated with worse cognitive performance in 2 domains. Additional research is needed to better understand the relationship between HIV RNA persistence during long-term ART and central nervous system complications in persons with HIV.
在接受抑制性抗逆转录病毒疗法（ART）的过程中，HIV 感染者仍存在认知并发症。ART 期间 HIV 水平较低可能导致这些并发症。在这项研究中，我们使用单拷贝检测（SCA）来测量脑脊液（CSF）中的 HIV，以研究低水平 HIV 与认知之间的可能关系。
方法/设计：分析了 96 名接受抑制性 ART 的连续配对 CSF-血浆标本中，平均 456 天内采集的 3 个 CSF 样本的 SCA 数据。使用混合模型，检查 SCA 检测到的 CSF HIV 作为认知功能下降的危险因素。
在 SCA 基线时，45.8%的参与者的血浆 HIV RNA 可检测（中位数为 8 拷贝/ml，可检测值的四分位间距为 3-17），17.7%的参与者的 CSF HIV RNA 可检测（中位数 CSF 浓度= 3 拷贝/ml，可检测值的四分位间距为 2-13）。CSF 中 CSF HIV RNA 的检测频率随时间下降（P = 0.018），血浆中呈下降趋势（P = 0.064）。研究期间检测到 CSF HIV RNA 与回忆（P = 0.014）和运动（P = 0.040）领域的表现较差相关，与整体认知表现较差相关（P = 0.078）。尽管在本队列中整合酶抑制剂的使用非常少见，但与 2 个领域的更好表现相关。
低水平 CSF HIV RNA 随时间下降，但与 2 个领域的认知功能下降相关。需要进一步研究以更好地了解长期 ART 期间 HIV RNA 持续存在与 HIV 感染者中枢神经系统并发症之间的关系。
