Abstract
CNS infection is a nearly constant facet of systemic CNS infection and is generally well controlled by suppressive systemic antiretroviral therapy (ART). However, there are instances when HIV can be detected in the cerebrospinal fluid (CSF) despite suppression of plasma viruses below the clinical limits of measurement. We review three types of CSF viral escape: asymptomatic, neuro-symptomatic, and secondary. The first, asymptomatic CSF escape, is seemingly benign and characterized by lack of discernable neurological deterioration or subsequent CNS disease progression. Neuro-symptomatic CSF escape is an uncommon, but important, entity characterized by new or progressive CNS disease that is critical to recognize clinically because of its management implications. Finally, secondary CSF escape, which may be even more uncommon, is defined by an increase of CSF HIV replication in association with a concomitant non-HIV infection, as a consequence of the local inflammatory response. Understanding these CSF escape settings not only is important for clinical diagnosis and management but also may provide insight into the CNS HIV reservoir.
| Original language | English |
|---|---|
| Pages (from-to) | 280-288 |
| Number of pages | 9 |
| Journal | Current HIV/AIDS Reports |
| Volume | 12 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Jun 1 2015 |
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Keywords
- Brain
- Central nervous system (CNS)
- Cerebrospinal fluid (CSF)
- Encephalitis
- HIV
- Treatment
ASJC Scopus subject areas
- Virology
- Infectious Diseases
Cite this
Cerebrospinal Fluid HIV Escape from Antiretroviral Therapy. / Ferretti, Francesca; Gisslen, Magnus; Cinque, Paola; Price, Richard W.
In: Current HIV/AIDS Reports, Vol. 12, No. 2, 01.06.2015, p. 280-288.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cerebrospinal Fluid HIV Escape from Antiretroviral Therapy
AU - Ferretti, Francesca
AU - Gisslen, Magnus
AU - Cinque, Paola
AU - Price, Richard W.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - CNS infection is a nearly constant facet of systemic CNS infection and is generally well controlled by suppressive systemic antiretroviral therapy (ART). However, there are instances when HIV can be detected in the cerebrospinal fluid (CSF) despite suppression of plasma viruses below the clinical limits of measurement. We review three types of CSF viral escape: asymptomatic, neuro-symptomatic, and secondary. The first, asymptomatic CSF escape, is seemingly benign and characterized by lack of discernable neurological deterioration or subsequent CNS disease progression. Neuro-symptomatic CSF escape is an uncommon, but important, entity characterized by new or progressive CNS disease that is critical to recognize clinically because of its management implications. Finally, secondary CSF escape, which may be even more uncommon, is defined by an increase of CSF HIV replication in association with a concomitant non-HIV infection, as a consequence of the local inflammatory response. Understanding these CSF escape settings not only is important for clinical diagnosis and management but also may provide insight into the CNS HIV reservoir.
AB - CNS infection is a nearly constant facet of systemic CNS infection and is generally well controlled by suppressive systemic antiretroviral therapy (ART). However, there are instances when HIV can be detected in the cerebrospinal fluid (CSF) despite suppression of plasma viruses below the clinical limits of measurement. We review three types of CSF viral escape: asymptomatic, neuro-symptomatic, and secondary. The first, asymptomatic CSF escape, is seemingly benign and characterized by lack of discernable neurological deterioration or subsequent CNS disease progression. Neuro-symptomatic CSF escape is an uncommon, but important, entity characterized by new or progressive CNS disease that is critical to recognize clinically because of its management implications. Finally, secondary CSF escape, which may be even more uncommon, is defined by an increase of CSF HIV replication in association with a concomitant non-HIV infection, as a consequence of the local inflammatory response. Understanding these CSF escape settings not only is important for clinical diagnosis and management but also may provide insight into the CNS HIV reservoir.
KW - Brain
KW - Central nervous system (CNS)
KW - Cerebrospinal fluid (CSF)
KW - Encephalitis
KW - HIV
KW - Treatment
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UR - http://www.scopus.com/inward/citedby.url?scp=84937762971&partnerID=8YFLogxK
U2 - 10.1007/s11904-015-0267-7
DO - 10.1007/s11904-015-0267-7
M3 - Article
C2 - 25860317
AN - SCOPUS:84937762971
VL - 12
SP - 280
EP - 288
JO - Current HIV/AIDS Reports
JF - Current HIV/AIDS Reports
SN - 1548-3568
IS - 2
ER -