Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Switzerland.
Infectious Diseases Department, Centre Hospitalier Alpes Léman, France.
J Acquir Immune Defic Syndr. 2023 Jul 1;93(3):219-228. doi: 10.1097/QAI.0000000000003189.
Despite modern antiretroviral therapy, human immunodeficiency virus-1 (HIV-1) ribonucleic acid (RNA) escape into the cerebrospinal fluid (CSF) may occur. We examined the prevalence of and factors associated with CSF HIV-1 escape among people living with HIV (PLWH) in Switzerland.
The Neurocognitive Assessment in the Metabolic and Aging Cohort study is an ongoing, prospective, longitudinal, multicenter study within the Swiss HIV Cohort Study. The neuro-HIV platform is a multidisciplinary, single-day outpatient consultation at Lausanne University Hospital.
We pooled data from the Neurocognitive Assessment in the Metabolic and Aging Cohort study and the neuro-HIV platform participants who underwent lumbar puncture between 2011 and 2019. Both patient groups had neurocognitive symptoms. Cerebrospinal fluid HIV-1 escape was defined as the presence of quantifiable CSF HIV-1 RNA when plasma HIV-1 RNA was suppressed or CSF HIV-1 RNA greater than plasma HIV-1 RNA when the latter was detectable.
Of 1166 PLWH assessed, 288 underwent lumbar puncture. Cerebrospinal fluid HIV-1 escape was observed in 25 PLWH (8.7%) of whom 19 (76%) had suppressed plasma HIV-1 RNA. Characteristics of PLWH were comparable whether they had CSF HIV-1 escape or not, including comorbidities, time since HIV diagnosis (15 vs 16 years, P = 0.9), median CD4 nadir (158.5/mm 3 vs 171/mm 3 , P = 0.6), antiretroviral CSF penetration-effectiveness score (7 vs 7 points, P = 0.8), and neurocognitive diagnosis based on Frascati criteria and radiological findings.
In this large pooled sample of PLWH with neurocognitive symptoms, CSF HIV-1 escape occurred in 8.7% of PLWH. People living with HIV with CSF HIV-1 escape presented no distinctive clinical or paraclinical characteristics. We conclude that lumbar puncture is unavoidable in confirming CSF HIV-1 escape.
尽管采用了现代抗逆转录病毒疗法，人类免疫缺陷病毒 1（HIV-1）的核糖核酸（RNA）仍可能逃逸到脑脊液（CSF）中。我们研究了瑞士 HIV 感染者（PLWH）中 CSF HIV-1 逃逸的流行情况及其相关因素。
神经认知评估代谢和老龄化队列研究是瑞士 HIV 队列研究内正在进行的一项前瞻性、纵向、多中心研究。神经 HIV 平台是洛桑大学医院的一个多学科、一日门诊咨询服务。
我们将神经认知评估代谢和老龄化队列研究和神经 HIV 平台参与者的数据进行了汇总，这些参与者在 2011 年至 2019 年期间接受了腰椎穿刺。这两组患者都有神经认知症状。CSF HIV-1 逃逸定义为当血浆 HIV-1 RNA 受到抑制时可定量检测到 CSF HIV-1 RNA，或当后者可检测到时 CSF HIV-1 RNA 大于血浆 HIV-1 RNA。
在接受评估的 1166 例 PLWH 中，有 288 例行腰椎穿刺。25 例（8.7%）PLWH 观察到 CSF HIV-1 逃逸，其中 19 例（76%）血浆 HIV-1 RNA 受到抑制。有无 CSF HIV-1 逃逸的 PLWH 的特征相似，包括合并症、HIV 诊断后时间（15 年与 16 年，P = 0.9）、中位数 CD4 细胞最低点（158.5/mm 3 与 171/mm 3 ，P = 0.6）、抗逆转录病毒 CSF 穿透有效性评分（7 分与 7 分，P = 0.8）和基于 Frascati 标准和影像学结果的神经认知诊断。
在这项有神经认知症状的大型 PLWH 汇总样本中，有 8.7%的 PLWH 出现 CSF HIV-1 逃逸。有 CSF HIV-1 逃逸的 HIV 感染者没有表现出独特的临床或临床前特征。我们的结论是，腰椎穿刺在确认 CSF HIV-1 逃逸时是不可避免的。
