Open AccessCerebrospinal fluid pleocytosis as a predictive factor for CSF and plasma HIV RNA discordance and escape
Author(s) -
Sérgio Monteiro de Almeida,
Indianara Rotta,
Ana Paula de Pereira,
Bin Tang,
Anya Umlauf,
Cléa Elisa Lopes Ribeiro,
Scott Letendre,
Ronald J. Ellis
Publication year - 2020
Publication title -
journal of neurovirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.868
H-Index - 85
eISSN - 1538-2443
pISSN - 1355-0284
DOI - 10.1007/s13365-020-00828-1
Subject(s) - cerebrospinal fluid , pleocytosis , csf pleocytosis , neurology , virology , immunology , medicine , human immunodeficiency virus (hiv) , pathology , psychiatry
The aims of this study were to investigate the frequency of HIV-1 RNA level discordance between the cerebrospinal fluid (CSF) and plasma and of CSF viral escape (CVE) in patients with HIV-1 subtype C on antiretroviral therapy, and evaluate the CSF white blood cell (WBC) performance characteristics in predicting CSF discordance in HIV+ group and the frequency of cognitive impairment in individuals with CSF HIV discordance or escape. HIV-1 RNA levels were assessed in plasma and CSF samples from 68 HIV+ participants without opportunistic infection. CSF discordance was found in 7.4% and CVE in 10%, with comparable frequencies between HIV-1B and C. Twenty samples (29%) showed increased CSF WBC counts. This group had higher CSF and plasma HIV-1 RNA levels than the group with normal WBC counts (p < 0.0001 and 0.006, respectively). The odds of CSF discordance were 18 times higher for a person with CSF WBC count of > 5 cells/mm 3 than the group with normal CSF WBC count. CSF WBC counts (cut-off of 15 cells/mm 3 ) showed high-performance characteristics as a predictive biomarker of CSF discordance (AUC the ROC curve 0.98). The frequency of cognitive impairment for CSF escape or discordance was 83% and 80%. The odds of cognitive impairment in these groups were 19 and 15 times higher than those for an HIV(-) person. Viral discordance or escape in the CNS occurs at a comparable frequency for HIV-1C and HIV-1B. The CSF WBC count was effective as a predictive biomarker of CSF and plasma discordance.