Cerebrospinal Fluid HIV Escape from Antiretroviral Therapy

Francesca Ferretti, Magnus Gisslen, Paola Cinque, Richard W. Price

Research output: Contribution to journalArticlepeer-review


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 languageEnglish
Pages (from-to)280-288
Number of pages9
JournalCurrent HIV/AIDS Reports
Issue number2
Publication statusPublished - Jun 1 2015


  • Brain
  • Central nervous system (CNS)
  • Cerebrospinal fluid (CSF)
  • Encephalitis
  • HIV
  • Treatment

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases


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