1. Neurosymptomatic HIV-1 CSF escape is associated with replication in CNS T cells and inflammation
- Author
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Kincer, Laura P., Dravid, Ameet, Trunfio, Mattia, Calcagno, Andrea, Zhou, Shuntai, Vercesi, Riccardo, Spudich, Serena, Gisslen, Magnus, Price, Richard W., Cinque, Paola, and Joseph, Sarah B.
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T cells -- Health aspects ,Inflammation -- Complications and side effects ,Central nervous system diseases -- Development and progression -- Risk factors ,Cerebrospinal fluid -- Health aspects ,HIV infection -- Complications and side effects -- Drug therapy ,Virus research ,Health care industry - Abstract
During antiretroviral therapy (ART), most people living with HIV-1 have undetectable HIV-1 RNA In their plasma. However, they occasionally present with new or progressive neurologic deficits and detectable HIV-1 RNA in the cerebrospinal fluid (CSF), a condition defined as neurosymptomatic HIV-1 CSF escape (NSE). We explored the source of neuropathogenesis and HIV-1 RNA in the CSF during NSE by characterizing HIV-1 populations and inflammatory biomarkers in CSF from 25 individuals with NSE. HIV-1 populations in the CSF were uniformly drug resistant and adapted to replication in [CD4.sup.+] T cells, but differed greatly in genetic diversity, with some having low levels of diversity similar to those observed during untreated primary infection and others having high levels like those during untreated chronic infection. Higher diversity in the CSF during NSE was associated with greater CNS inflammation. Finally, optimization of ART regimen was associated with viral suppression and improvement of neurologic symptoms. These results are consistent with CNS inflammation and neurologic injury during NSE being driven by replication of partially drug-resistant virus in CNS [CD4.sup.+] T cells. This is unlike nonsuppressible viremia in the plasma during ART, which typically lacks clinical consequences and is generated by virus expression without replication., Introduction The CNS is an immune-privileged compartment where inflammation is typically limited due to its potential pathogenic effects. For example, neuroinflammation is known to be a contributor in the development [...]
- Published
- 2024
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