Paper # 432|
CSF Escape Is Uncommon in HIV-1-infected Patients on Stable ART
Arvid Edén1, R Price2, L Hagberg1, and M Gisslén1
1The Sahlgrenska Academy at Univ of Gothenburg, Sahlgrenska Univ Hosp, Sweden and 2Univ of California, San Francisco and San Francisco Gen Hosp, US
Background: ART effectively reduces HIV-1 RNA in plasma, as well as in
cerebrospinal fluid (CSF). Occasionally, patients exhibit CSF escape, or
elevated RNA levels in CSF while effectively suppressed in plasma. Here, we
examine CSF escape in patients effectively treated with ART in relation to
were 63 patients from 2 centers treated with ART
regimens of either efavirenz, lopinavir/ritonavir or atazanavir/ritonavir in
combination with 2 NRTI’s consisting of lamivudine or emtricitabine with either
tenofovir, abacavir, or zidovudine for at least 6 months, with undetectable
(<50 copies/mL) HIV-1 RNA in plasma were included in the analysis. HIV-1 RNA
was analysed with Roche Amplicore v.1.5 or Cobas Taqman v.1.0. Fisher’s exact
test was used for statistical analysis.
63 identified patients, 7 (11 %) had signs of CSF escape with detectable HIV-1
RNA levels in CSF (range: 46 to 213 copies/mL) despite having undetectable levels
in blood. Five of 24 (21 %) efavirenz-treated and 2/13 (15 %)
atazanavir-treated patients had detectable RNA in CSF. Of 26 lopinavir-treated
patients, none had detectable CSF-RNA, with significantly lower frequency of
CSF escape compared to efavirenz-treated patients (P =0.02). Other
differences between treatment regimens did not reach statistical significance;
3/17 (18 %) and 4/27 (15 %) of patients treated with abacavir and tenofovir had
detectable CSF RNA, respectively. Nineteen patients received a NRTI backbone
containing zidovudine, none of which had detectable CSF RNA.
Conclusions: CSF escape, measured as detectable CSF HIV-1 RNA, remains an
uncommon finding in patients with successful suppression of plasma viral load.
However, there may be cause for consideration of specific ART regimen regarding
CNS efficacy, especially in patients with HIV-1 related neurological disease.
In our material, CSF escape was most common in patients treated with efavirenz
in combination with either abacavir or tenofovir. Of note, no patients treated
with the PI lopinavir/ritonavir, or the NRTI zidovudine, had detectable CSF
HIV-1 RNA, while retaining undetectable plasma viral load.