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Cerebrospinal fluid response to structured treatment interruption after virological failure
R W Price1, E E Paxinos, R M Grant
1Department of Neurology, University of California San Francisco and San Francisco General Hospital, 94110-3518, USA. price@itsa.ucsf.edu
AIDS (London, England)
|June 27, 2001
Summary
Structured antiretroviral treatment interruption (STI) for HIV-1 may lead to increased cerebrospinal fluid (CSF) viral exposure and altered lymphocyte counts. Antiretroviral therapy before interruption suppressed CSF HIV-1 more effectively than plasma HIV-1.
Area of Science:
- Neurovirology
- Immunology
- Antiretroviral Therapy
Background:
- Structured antiretroviral treatment interruption (STI) is a proposed strategy for HIV-1 management.
- Understanding HIV-1 dynamics in the central nervous system during STI is crucial.
Purpose of the Study:
- To investigate cerebrospinal fluid (CSF) HIV-1 infection during structured antiretroviral treatment interruption (STI).
- To monitor HIV-1 RNA, drug resistance, and immune cell changes in CSF and plasma.
Main Methods:
- Prospective observational study involving five patients with HIV-1 undergoing STI.
- Quantification of HIV-1 RNA in CSF and plasma.
- Assessment of phenotypic drug susceptibility and genotypic resistance mutations.
- CSF white blood cell counts and neurological status monitoring.
Main Results:
- CSF HIV-1 RNA increased faster than plasma HIV-1 in four patients.
- Three patients developed asymptomatic CSF lymphocytic pleocytosis.
- Simultaneous shifts in HIV-1 quasispecies from drug-resistant to drug-susceptible phenotypes were observed in both CSF and plasma.
Conclusions:
- STI may involve uncharacterized changes in tissue viral exposure and lymphocyte trafficking.
- Antiretroviral treatment prior to interruption effectively suppressed CSF HIV-1 and CSF lymphocyte traffic.
- Simultaneous resistance mutation changes suggest viral exchange between CSF and plasma compartments, potentially linked to lymphocytosis.