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Cerebrospinal Fluid HIV Escape from Antiretroviral Therapy

  • Central Nervous System and Cognition (SS Spudich, Section Editor)
  • Published:
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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.

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Conflict of Interest

Francesca Ferretti declares payment from Bristol-Myers Squibb for educational presentation and travel expenses.

Magnus Gisslen declares payment for board memberships on the Scientific Advisory Boards from Gilead, Janssen, BMS, MSD, and GSK/ViiV, and honoraria payment for lectures from BMS, Gilead, Janssen, AbbVie, and GSK/ViiV, and declares travel expenses paid for by Gilead.

Paola Cinque declares a grant from Gilead Sciences and payment for educational presentation, board membership or travel expenses from AbbVie, Bristol-Myers-Squibb, Gilead, Janssen, Viiv, and Merck.

Richard W. Price declares payment from a one-time consultation meeting with Merck & Co., an honorarium for a talk at a scientific meeting with AbbVie, and travel expenses covered by AbbVie.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

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

    Francesca Ferretti & Paola Cinque

  2. Department of Infectious Diseases, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

    Magnus Gisslen

  3. Department of Neurology, University of California San Francisco, San Francisco, USA

    Richard W. Price

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  1. Francesca Ferretti
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  2. Magnus Gisslen
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  3. Paola Cinque
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Correspondence to Paola Cinque.

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

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Ferretti, F., Gisslen, M., Cinque, P. et al. Cerebrospinal Fluid HIV Escape from Antiretroviral Therapy. Curr HIV/AIDS Rep 12, 280–288 (2015). https://doi.org/10.1007/s11904-015-0267-7

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