| Publication Abstract Display | | Type: Published Abstract | | Title: Frequent dissociation of CSF and plasma HIV RNA responses during antiretroviral therapy. | | Authors: Letendre S, Ellis R, McCutchan J, and the HNRC Group | | Year: 2001 | | Publication: 8th Conference on Retroviruses and Opportunistic Infections | | Volume: Issue: Pages: | | Abstract:Background: The CNS and plasma/lymphatic compartments differ in the cell types infected by HIV and the concentrations of antiretrovirals, leading to differences in replication that may foster independent evolution of HIV. Combination ART suppresses plasma HIV replication in the majority of participants in clinical trials but documentation of the response of CSF HIV RNA levels is limited. Methods: Subjects were 20 HIV-infected patients (pts) on no or failing ART who enrolled in a prospective, open-label study of the effects of individualized ART on cognitive function. A median of 3 new agents were started at baseline (BL) and response to therapy was defined as a decrease in HIV RNA by at least 0.5 log c/ml. Matched CSF and blood specimens were obtained every 6 to 12 weeks (wk). 14/20 (70%) remained in the study beyond 12 wk (median 47 wk). Four groups were defined by viral responses during the first 12 wk in plasma (P), CSF (C), both (PC), or neither (0). HIV RNA was measured by RT-PCR. Results: Median (range) BL values: CD4=167 (3-668), plasma RNA=4.81 (2.65-6.35), CSF RNA=3.66 (2.45-6.16). Median changes at wk 12: CD419 [(-118)-(+183)], plasma RNA=-0.82 [(-3.76)-(+0.84)], CSF RNA=-1.39 [(-3.40)-(+0.27)]. Proportion of pts in each response group at wk 12: group PC=12/20 (60%), group C=4/20 (20%), group P=1/20 (5%), group 0=3/20 (15%). Viral response in both compartments was associated with higher CSF RNA levels at BL (median 4.19 vs. 3.48, p=0.07) and initiation of more new agents (median 3 vs. 2, p=0.08). Of 14 followed >12wk, 8 were in group PC. Of these, 4/8 (50%) maintained CSF suppression but only 2 maintained suppression in both fluids (25%). Conclusions: Most patients initiating new ART will respond in both plasma and CSF and responses may be more frequent and durable in CSF than plasma. Combination ART with at least 3 agents may result in better suppression in both fluids. However, dissociation of responses may occur in a quarter of patients and may be sustained beyond 12 weeks. |
return to publications listing
|