Changes in CSF and plasma HIV-1 RNA and cognition after starting potent antiretroviral therapy

Marra, Christina M.; Lockhart, David; Zunt, Joseph R.; Perrin, M.; Coombs, Robert W.; Collier, Ann C.

doi:10.1212/01.wnl.0000058768.73358.1a

Cited by 73 publications

(55 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Marra et al first reported the association of cognitive improvement with CSF viral load reductions. 40 Similarly, significant improvement in neurologic and NP functioning and significant decline in CSF HIV RNA after HAART initiation or HAART change were reported. 41 These observations were extended by Letendre et al 39 who demonstrated that CSF HIV RNA suppression was an independent predictor of cognitive improvement.…”

Section: Haart Improves Neurocognitive Functionmentioning

confidence: 91%

“…ARV drugs are considerably different not only in their CSF levels, but also in their capacity to reduce CSF HIV RNA to undetectable levels 40,52 and improve cognition. 8,24,50 The optimal treatment for HAND has not been established, but the general consensus is that the ability of ARV drugs to reach the CNS is a critical factor for patients' neurological response.…”

Section: Recent Findingsmentioning

confidence: 99%

“…8,24,50 The optimal treatment for HAND has not been established, but the general consensus is that the ability of ARV drugs to reach the CNS is a critical factor for patients' neurological response. 9 Several ARV drugs, or drug combinations, have been shown to be more neurologically active than others on the basis of their capacity to suppress CSF viral load 40,52 and improve NP performance. 8,24,50 Moreover, it has been shown that virologic suppression in the CSF is associated with significant NP improvement.…”

Section: Recent Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive function in treated HIV patients

Tozzi¹

2010

NBHIV

View full text Add to dashboard Cite

Although highly active antiretroviral therapy (HAART) has reduced the incidence of HIV-associated dementia, the overall prevalence of HIV-associated neurocognitive disorders (HAND) has increased. Since treatment and prevention of HAND are becoming an increasing concern, management strategies for cognitive impairment in patients living with HIV are expected to play an important role in the near future. This review summarizes the existing literature on studies investigating cognitive functions in patients receiving antiretroviral (ARV) treatment.Most studies indicate that HAART use results in improvement of neurocognitive functions, yet milder forms of HAND are not only prevalent, but also incident in patients with persistently undetectable plasma HIV RNA. We performed a systematic review on all studies performed in patients receiving ARV treatment that included neurocognitive evaluations as study end points. Thirty-six studies were examined. Study methodology varied from cross-sectional to doubleblind, randomized, controlled designs. Aside from historic zidovudine monotherapy trials, in most studies, ARV schemes varied considerably, and in some cases, ARV regimens were not reported in detail. Only a few articles included virological studies on cerebrospinal fluid. Study duration was ,2 years in most cases. Differences in study design and presence of study limitations may account for difficulties in understanding the impact of HAART on cognition and in evaluating the effect of an individual agent or ARV regimen on cognitive functioning. The aim of the present article is to provide HIV clinicians with a comprehensive review of recent achievements and future prospects for ARV treatment and prevention of cognitive dysfunctions in HIV-infected patients.

show abstract

Section: Haart Improves Neurocognitive Functionmentioning

confidence: 91%

Section: Recent Findingsmentioning

confidence: 99%

Section: Recent Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Cognitive function in treated HIV patients

Tozzi¹

2010

NBHIV

View full text Add to dashboard Cite

show abstract

“…In all patients presenting with neurological signs and symptoms in whom a diagnostic lumbar puncture is indicated, the measurement of HIV-RNA in CSF should be added to all specific tests being performed to diagnose opportunistic infections (A-II). All patients with advanced naïve HIV infection should undergo an accurate assessment of neuropsychological status using a validated cognitive test battery or a standardized scale for clinical measurements [71,72]. This assessment should be repeated during follow-up in patients having a cognitive impairment and an abnormal baseline test result (A-II).…”

Section: Neurocognitive Impairmentmentioning

confidence: 99%

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Quantitative amplification techniques of HIV-1 RNA in different body fluids, including cerebrospinal fluid (CSF), have been applied to HIV-infected adults and children but, in contrast to plasma HIV levels, their predictive value has not been well established (McARTHUR et al 2003, MARRA et al 2003.…”

Section: Introductionmentioning

confidence: 99%

Analysis of correlation between cerebrospinal fluid and plasma HIV-1 RNA levels in patients with neurological opportunistic diseases

Christo

Greco

Aleixo

et al. 2011

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

SUMMARYThe question of whether HIV-1 RNA in cerebrospinal fluid (CSF) is derived from viral replication in the central nervous system or simply reflects the transit of infected lymphocytes from the blood compartment has long been a matter of debate. Some studies found no correlation between CSF and plasma viral load, whereas others did. The lack of a correlation between the two compartments suggests that the presence of HIV-1 RNA is not simply due to the passive passage of the virus from blood to CSF but rather due to intrathecal replication. To evaluate the correlation between plasma and CSF HIV-1 RNA levels and to identify situations in which there is no correlation between the two compartments, seventy patients were prospectively studied. The association between CSF and plasma viral load was evaluated in the total population and in subgroups of patients with similar characteristics. A correlation between the CSF and plasma compartments was observed for patients undergoing highly active antiretroviral therapy (HAART), those with a CD4 T lymphocyte count lower than 200 cells/mm 3 , and those with increased CSF protein content. On the other hand, no correlation was observed for patients without adequate virological control, who had a CD4 count higher than 200 cells/mm 3 and who did not use HAART. The correlation between the two compartments observed in some patients suggests that CSF HIV-1 RNA levels may reflect plasma levels in these subjects. In contrast, the lack of a correlation between the two compartments in patients who were not on HAART and who had normal CSF proteins and a poor virological control possibly indicates compartmentalization of the virus in CSF and, consequently, plasma-independent intrathecal viral replication.

show abstract

Changes in CSF and plasma HIV-1 RNA and cognition after starting potent antiretroviral therapy

Cited by 73 publications

References 6 publications

Cognitive function in treated HIV patients

Cognitive function in treated HIV patients

Italian Consensus Statement on Management of HIV-Infected Individuals with Advanced Disease Naïve to Antiretroviral Therapy

Analysis of correlation between cerebrospinal fluid and plasma HIV-1 RNA levels in patients with neurological opportunistic diseases

Contact Info

Product

Resources

About