HIV escape into cerebrospinal fluid (CSF) may take place in virally suppressed people living with HIV, but it is not a common occurrence and does not appear to cause neurocognitive harm, a study published in AIDS showed.
Fifty-five (4.4%) of 1,264 participants with plasma viral loads of < 50 copies/ml who were on stable antiretroviral therapy had the virus in their spinal fluid. The odds of CSF viral escape were greater among those on ritonavir (Norvir)-boosted protease inhibitors (odds ratio [OR] = 2.0) or unboosted atazanavir (Reyataz, OR = 5.1) compared to NNRTI-based regimens. While previous studies suggested that this association may be related to lower effectiveness of some antiretrovirals in the central nervous system (CNS), participants on PI-based regimens may have had other risk factors, study authors noted.
HIV in the cerebrospinal fluid was also associated with markers of CNS inflammation, although not with worse neurocognitive performance. The lack of association between inflammation and neurocognitive performance could be due to transient rather than persistent escapes or to the low number of participants with any viral escape, they explained.
Authors called for longitudinal research into the relationship of CSF viral escapes, CNS inflammation, and long-term CNS outcomes.