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Relapse of Symptomatic Cerebrospinal Fluid HIV Escape

  • Central Nervous System and Cognition (SS Spudich, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Symptomatic cerebrospinal fluid (CSF) HIV escape defines the presence of neurological disease in combination antiretroviral therapy (cART)-treated persons due to HIV replication in CSF despite systemic suppression or to higher viral replication in CSF than in plasma. The aim was to search for cases of recurrent symptomatic CSF escape and to define their characteristics.

Recent Findings

By review of the literature, we identified symptomatic CSF escape relapses in three patients who had shown clinical remission of a first escape episode following cART optimization. By examination of our cohort of 21 patients with symptomatic CSF escape, we identified five additional patients. In the latter, viral escape relapsed over a median follow-up of 108 months because of low adherence or upon treatment simplification of a previously optimized regimen. cART reoptimization based on resistance profile and potential drug neuropenetration and efficacy led to relapse resolution with no further episodes after a median follow-up of 50 months from relapse.

Summary

The observation that CSF escape may relapse highlights the importance of long-term neuro-suppressive regimens after a first episode and supports the role of the brain as a reservoir for HIV.

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Acknowledgments

We wish to thank the colleagues at the Department of Infectious Diseases, San Raffaele Hospital, for help with the patients’ management and follow-up.

Funding

This work was supported by the Italian Gilead Sciences Fellowship Program and by the National Institutes of Health (National Institute of Allergy and Infectious Diseases, R01NS094067-01) to PC.

Author information

Author notes

  1. Francesca Ferretti

    Present address: Chelsea and Westminster Hospital NHS Trust, London, UK

  2. Simonetta Gerevini

    Present address: Unit of Neuroradiology, Ospedali Riuniti, Bergamo, Italy

Authors and Affiliations

  1. Department of Infectious Diseases, San Raffaele Scientific Institute and San Raffaele Vita-Salute University, Via Stamira d’Ancona 20, 20127, Milan, Italy

    Francesca Ferretti, Valentina De Zan, Filippo Turrini, Nicola Gianotti, Hamid Hasson, Adriano Lazzarin & Paola Cinque

  2. Unit of Neuroradiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Simonetta Gerevini

  3. Laboratory of Microbiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Enzo Boeri

Authors
  1. Francesca Ferretti
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  2. Valentina De Zan
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  3. Simonetta Gerevini
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  4. Filippo Turrini
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  5. Enzo Boeri
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  6. Nicola Gianotti
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  7. Hamid Hasson
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  8. Adriano Lazzarin
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  9. Paola Cinque
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Corresponding author

Correspondence to Paola Cinque.

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Conflict of Interest

NG reports personal fees from Gilead Sciences, Janssen Cilag, ViiV Healthcare, and Merck Sharp and Dohme. AL reports personal fees from Gilead Sciences, Janssen Cilag, ViiV Healthcare, and Merck Sharp and Dohme. PC reports personal fees from Gilead Sciences, Janssen Cilag, ViiV Healthcare, Pfizer, and Shire. The remaining authors have no conflict of interest to declare.

Human and Animal Rights and Informed Consent

The patients from our clinic were followed by standard diagnostic and treatment procedures. However, they were part of a study approved by the Ethical Committee of our Institute and gave written permission to the use of clinical data.

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This article is part of the Topical Collection on Central Nervous System and Cognition

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Ferretti, F., De Zan, V., Gerevini, S. et al. Relapse of Symptomatic Cerebrospinal Fluid HIV Escape. Curr HIV/AIDS Rep 17, 522–528 (2020). https://doi.org/10.1007/s11904-020-00526-x

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  • DOI: https://doi.org/10.1007/s11904-020-00526-x

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