Francesca Ferretti1,2, Valentina De Zan1, Simonetta Gerevini3,4, Filippo Turrini1, Enzo Boeri5, Nicola Gianotti1, Hamid Hasson1, Adriano Lazzarin1, Paola Cinque6. 1. Department of Infectious Diseases, San Raffaele Scientific Institute and San Raffaele Vita-Salute University, Via Stamira d'Ancona 20, 20127, Milan, Italy. 2. Chelsea and Westminster Hospital NHS Trust, London, UK. 3. Unit of Neuroradiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. 4. Unit of Neuroradiology, Ospedali Riuniti, Bergamo, Italy. 5. Laboratory of Microbiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. 6. Department of Infectious Diseases, San Raffaele Scientific Institute and San Raffaele Vita-Salute University, Via Stamira d'Ancona 20, 20127, Milan, Italy. cinque.paola@hsr.it.
Abstract
PURPOSE OF REVIEW: Symptomatic cerebrospinal fluid (CSF) HIV escape defines the presence of neurological disease in combination antiretroviral therapy (cART)-treated persons due to HIV replication in CSF despite systemic suppression or to higher viral replication in CSF than in plasma. The aim was to search for cases of recurrent symptomatic CSF escape and to define their characteristics. RECENT FINDINGS: By review of the literature, we identified symptomatic CSF escape relapses in three patients who had shown clinical remission of a first escape episode following cART optimization. By examination of our cohort of 21 patients with symptomatic CSF escape, we identified five additional patients. In the latter, viral escape relapsed over a median follow-up of 108 months because of low adherence or upon treatment simplification of a previously optimized regimen. cART reoptimization based on resistance profile and potential drug neuropenetration and efficacy led to relapse resolution with no further episodes after a median follow-up of 50 months from relapse. The observation that CSF escape may relapse highlights the importance of long-term neuro-suppressive regimens after a first episode and supports the role of the brain as a reservoir for HIV.
PURPOSE OF REVIEW: Symptomatic cerebrospinal fluid (CSF) HIV escape defines the presence of neurological disease in combination antiretroviral therapy (cART)-treated persons due to HIV replication in CSF despite systemic suppression or to higher viral replication in CSF than in plasma. The aim was to search for cases of recurrent symptomatic CSF escape and to define their characteristics. RECENT FINDINGS: By review of the literature, we identified symptomatic CSF escape relapses in three patients who had shown clinical remission of a first escape episode following cART optimization. By examination of our cohort of 21 patients with symptomatic CSF escape, we identified five additional patients. In the latter, viral escape relapsed over a median follow-up of 108 months because of low adherence or upon treatment simplification of a previously optimized regimen. cART reoptimization based on resistance profile and potential drug neuropenetration and efficacy led to relapse resolution with no further episodes after a median follow-up of 50 months from relapse. The observation that CSF escape may relapse highlights the importance of long-term neuro-suppressive regimens after a first episode and supports the role of the brain as a reservoir for HIV.