Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load

OBJECTIVE: To characterize HIV-infected patients with neurosymptomatic cerebrospinal fluid (CSF) 'escape', defined as detectable CSF HIV RNA in the setting of treatment-suppressed plasma levels or CSF RNA more than 1-log higher than plasma RNA. DESIGN: Retrospective case series. SETTING: Four urban medical centers in the United States and Europe. PARTICIPANTS: Virologically controlled HIV-infected patients on antiretroviral therapy (ART) with progressive neurologic abnormalities who were determined to have CSF 'escape'. INTERVENTION: Optimization of ART based upon drug susceptibility and presumed central nervous system exposure. MAIN OUTCOME MEASURES: Levels of CSF HIV RNA and inflammatory markers, clinical signs and symptoms, and MRI findings. RESULTS: Ten patients presented with new neurologic abnormalities, which included sensory, motor, and cognitive manifestations. Median CSF HIV RNA was 3900copies/ml (range 134-9056), whereas median plasma HIV RNA was 62copies/ml (range