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Treatment intensification has no effect on the HIV-1 central nervous system infection in patients on suppressive antiretroviral therapy.
- Source :
-
Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2010 Dec 15; Vol. 55 (5), pp. 590-6. - Publication Year :
- 2010
-
Abstract
- Background: Antiretroviral treatment (ART) significantly reduces cerebrospinal fluid (CSF) HIV-1 RNA levels and residual viremia is less frequently found in CSF than in blood. However, persistent intrathecal immunoactivation is common, even after several years of ART. To investigate whether low-level CSF viremia and residual immunoactivation within the central nervous system (CNS) derive from ongoing local viral replication, we conducted a study of treatment intensification in patients on effective ART.<br />Methods: Ten patients on ART with plasma HIV RNA <50 copies per milliliter for >18 months were included. Intensification was given for in total 8 weeks: 4 weeks with maraviroc or lopinavir/ritonavir (good CNS penetration), and 4 weeks with enfuvirtide (poor CNS penetration). Lumbar punctures were performed 4 weeks before, at intensification commencement, at switchover after 4 weeks, at the conclusion of, and 4 weeks after the intensification period.<br />Results: No significant changes in HIV RNA, neopterin, β2-microglobulin, immunoglobulin G index, albumin ratio, and CD4(+) T-cell count were observed, either in CSF or blood, neither before, during, nor after the intensification periods.<br />Conclusions: ART intensification did not reduce residual CSF HIV RNA levels or intrathecal immunoactivation in patients on ART. These findings do not support an ongoing viral replication in CNS.
- Subjects :
- Adult
Albumins cerebrospinal fluid
Anti-HIV Agents blood
Anti-HIV Agents cerebrospinal fluid
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
CD4-Positive T-Lymphocytes virology
Cross-Over Studies
Cyclohexanes therapeutic use
Enfuvirtide
Female
HIV Envelope Protein gp41 therapeutic use
HIV-1 physiology
Humans
Immunoglobulin G blood
Immunoglobulin G cerebrospinal fluid
Lopinavir therapeutic use
Male
Maraviroc
Middle Aged
Neopterin blood
Neopterin cerebrospinal fluid
Peptide Fragments therapeutic use
Polymerase Chain Reaction
RNA, Viral blood
RNA, Viral cerebrospinal fluid
Ritonavir therapeutic use
Triazoles therapeutic use
Viral Load
Viremia
Virus Replication
Anti-HIV Agents therapeutic use
Central Nervous System Infections drug therapy
Central Nervous System Infections virology
HIV Infections drug therapy
HIV Infections virology
HIV-1 drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1944-7884
- Volume :
- 55
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of acquired immune deficiency syndromes (1999)
- Publication Type :
- Academic Journal
- Accession number :
- 20847699
- Full Text :
- https://doi.org/10.1097/QAI.0b013e3181f5b3d1