Date Published:
2017 Jan 01

Publication Type:
Journal Article

Authors:

A.M. Anderson
J.A. Muñoz-Moreno
D.R. McClernon
R.J. Ellis
D. Cookson
D.B. Clifford
A.C. Collier
B.B. Gelman
C.M. Marra
J.C. McArthur
A. McCutchan
S. Morgello
N. Sacktor
D.M. Simpson
D.R. Franklin
R.K. Heaton
I. Grant
S.L. Letendre

Secondary:
J Infect Dis

Volume:
215

Pagination:
105-113

Issue:
1

PMID:
27789723

URL:
https://pubmed.ncbi.nlm.nih.gov/27789723

DOI:
10.1093/infdis/jiw505

Keywords:
Adult;Anti-HIV Agents;CD4 Lymphocyte Count;Female;HIV Infections;HIV-1;Humans;Male;Middle Aged;neurocognitive disorders;Prevalence;RNA, Viral;Viral Load

Abstract:
<p>BACKGROUND:  Neurocognitive disorders remain common among human immunodeficiency virus (HIV)-positive adults, perhaps owing to persistent HIV-1 RNA in cerebrospinal fluid (CSF) during antiretroviral therapy (ART).METHODS:  Using a single-copy assay, we measured HIV-1 RNA levels in CSF and plasma specimens from 220 HIV-positive adults who were taking suppressive ART. Fifty-five participants were tested twice.RESULTS:  HIV-1 RNA was detected in 42.3% of CSF and 65.2% of plasma samples. Correlates of higher CSF HIV-1 RNA levels included higher nadir and current CD4 T-cell counts, a plasma HIV-1 RNA level of ≥ 1 copy/mL, and a lower central nervous system penetration-effectiveness score (model P < .001). Worse neurocognitive performance was associated with discordance in HIV-1 RNA detection between plasma and CSF, lower overall CSF HIV-1 RNA level, and longer ART duration, among others (model P < .001). In the longitudinal subgroup, CSF HIV-1 RNA persisted in most participants (69%) over 7 months.CONCLUSIONS:  Low-level HIV-1 RNA in CSF is common during suppressive ART and is associated with low-level HIV-1 RNA in blood, better immune status, and lower ART drug distribution into CSF. The association between HIV-1 RNA discordance and HIV-associated neurocognitive disorder (HAND) may reflect compartmentalization. The relationship between HAND, lower HIV-1 RNA levels in CSF, and lower CD4 T-cell counts may reflect disturbances in the immune response to HIV-1 in the CNS.</p>