Low-Level HIV RNA in Cerebrospinal Fluid and Neurocognitive Performance: A Longitudinal Cohort Study.

Area of Science:

• Neuroscience
• Virology
• Immunology

Background:

• Cognitive impairments remain a challenge for individuals with HIV, even with effective antiretroviral therapy (ART).
• Subtle presence of HIV in the central nervous system (CNS) during ART may contribute to these cognitive deficits.
• Investigating low-level HIV in cerebrospinal fluid (CSF) is crucial for understanding persistent neurological complications.

Purpose of the Study:

• To measure HIV levels in CSF using a sensitive single-copy assay (SCA).
• To explore the association between detectable CSF HIV RNA and neurocognitive performance in individuals on suppressive ART.
• To analyze the temporal trends of HIV RNA in CSF and plasma during ART.

Main Methods:

• Analysis of consecutively paired CSF-plasma specimens from 96 participants on suppressive ART.
• Utilized a single-copy assay (SCA) for sensitive detection of HIV RNA in CSF and plasma.
• Employed mixed-effects models to assess CSF HIV RNA as a predictor of neurocognitive outcomes.

Main Results:

• At baseline, 17.7% of participants had detectable CSF HIV RNA (median 3 copies/mL) and 45.8% had detectable plasma HIV RNA (median 8 copies/mL).
• CSF HIV RNA detection frequency decreased over time (P=0.018), with a similar trend in plasma (P=0.064).
• Detectable CSF HIV RNA was significantly associated with worse performance in recall (P=0.014) and motor (P=0.040) domains, and a trend towards poorer global performance (P=0.078).

Conclusions:

• Low-level HIV RNA in CSF decreases during ART but remains associated with impaired cognitive domains.
• The findings highlight the need for further investigation into the relationship between persistent HIV RNA in the CNS and cognitive decline.
• Understanding these CNS complications is vital for improving long-term outcomes for people with HIV.