Kinetics of HIV-1 in Cerebrospinal Fluid and Plasma in Cryptococcal Meningitis

Cecchini, Diego; Cañizal, Ana M; Rojas, Haroldo; Arechavala, Alicia; Negroni, Ricardo; Bouzas, María Belén; Benetucci, Jorge

doi:10.4081/idr.2012.e30

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…The HIV-1 VL was comparable between the compartments at the first two time points but higher in plasma than CSF on day 14, mainly due to a decrease in CSF HIV-1 VL. One study reported significantly higher HIV-1 VL in plasma than CSF at all three-time points [ 38 ]. In another study where the CSF and plasma HIV-1 VL were compared on days 1 and 14, plasma HIV-1 VL was reported to be higher than CSF HIV-1 VL on both days [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Reversal of CSF HIV-1 Escape during Treatment of HIV-Associated Cryptococcal Meningitis in Botswana

et al. 2022

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Cerebrospinal fluid (CSF) viral escape has been poorly described among people with HIV-associated cryptococcal meningitis. We determined the prevalence of CSF viral escape and HIV-1 viral load (VL) trajectories in individuals treated for HIV-associated cryptococcal meningitis. A retrospective longitudinal study was performed using paired CSF and plasma collected prior to and during the antifungal treatment of 83 participants recruited at the Botswana site of the phase-3 AMBITION-cm trial (2018–2021). HIV-1 RNA levels were quantified then CSF viral escape (CSF HIV-1 RNA ≥ 0.5 log10 higher than plasma) and HIV-1 VL trajectories were assessed. CSF viral escape occurred in 20/62 (32.3%; 95% confidence interval [CI]: 21.9–44.6%), 13/52 (25.0%; 95% CI: 15.2–38.2%) and 1/33 (3.0%; 95% CI: 0.16–15.3%) participants at days 1, 7 and 14 respectively. CSF viral escape was significantly lower on day 14 compared to days 1 and 7, p = 0.003 and p = 0.02, respectively. HIV-1 VL decreased significantly from day 1 to day 14 post antifungal therapy in the CSF but not in the plasma (β = −0.47; 95% CI: −0.69 to −0.25; p < 0.001). CSF viral escape is high among individuals presenting with HIV-associated cryptococcal meningitis; however, antifungal therapy may reverse this, highlighting the importance of rapid initiation of antifungal therapy in these patients.

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Section: Discussionmentioning

confidence: 99%

Reversal of CSF HIV-1 Escape during Treatment of HIV-Associated Cryptococcal Meningitis in Botswana

et al. 2022

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“…75 Whether HIV replication in the brain is independent of replication in plasma of patients with OI is still a matter of debate. The finding of high levels of divergent human immunodeficiency virus 1 (HIV-1) quasispecies, higher viral loads in opportunistic neurological infections that are independent of plasma viral load and CD4 count, 72,76 and different viral kinetics of HIV-1 in the CSF 77 implies that there is a local source of HIV in the brain that could influence both neurological disease occurrence and outcomes.…”

Section: General Concept: Hiv Is Not Lonely In the Brainmentioning

confidence: 99%

“…The most impaired cognitive domains were psychomotor, learning, and memory for neurotoxoplasmosis survivors and psychomotor and speed of information processing for PML survivors. Patients with OIs without significant brain destruction, such as CNM, may present a spontaneous decline in HIV CSF viral load 77 following acute infection and may also improve their cognitive function after an initial significant short-term decline. 79 Interestingly, a recent study described significant deficits in neurocognitive function in advanced HIV/AIDS individuals with positive C neoformans antigenemia in CSF but with no meningitis that improved after initiation of preemptive fluconazole treatment and cART.…”

Section: General Concept: Hiv Is Not Lonely In the Brainmentioning

confidence: 99%

Human Immunodeficiency Virus in the Brain—Culprit or Facilitator?

Ene

2018

Infect Dis (Auckl)

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Introduction:Human immunodeficiency virus (HIV) enters the brain early, where it can persist, evolve, and become compartmentalized. Central nervous system (CNS) disease can be attributed to HIV alone or to the complex interplay between the virus and other neurotropic pathogens.Aim:The current review aims to describe the direct impact of HIV on the brain as well as its relationship with other pathogens from a practitioner’s perspective, to provide a general clinical overview, brief workup, and, whenever possible, treatment guidance.Methods:A review of PubMed was conducted to identify studies on neuropathogenesis of HIV in relation to host responses. Furthermore, the interaction between the CNS pathogens and the host damage responses were revised in the setting of advanced and also well-controlled HIV infection.Results:Similar to other pathogens, HIV leads to CNS immune activation, inflammation, and viral persistence. Therefore, almost half of the infected individuals present with neurocognitive disorders, albeit mild. Compartmentalized HIV in the CNS can be responsible in a minority of cases for the dramatic presentation of symptomatic HIV escape. Disruption of the immune system secondary to HIV may reactivate latent infections or allow new pathogens to enter the CNS. Opportunistic infections with an inflammatory component are associated with elevated HIV loads in the cerebrospinal fluid and also with greater cognitive impairment. The inflammatory immune reconstitution syndrome associated with CNS opportunistic infections can be a life-threatening condition, which needs to be recognized and managed by efficiently controlling the pathogen burden and timely balanced combination antiretroviral therapy. Latent neurotropic pathogens can reactivate in the brain and mimic HIV-associated severe neurological diseases or contribute to neurocognitive impairment in the setting of stable HIV infection.Conclusions:As HIV can be responsible for considerable brain damage directly or by facilitating other pathogens, more effort is needed to recognize and manage HIV-associated CNS disorders and to eventually target HIV eradication from the brain.

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Kinetics of HIV-1 in Cerebrospinal Fluid and Plasma in Cryptococcal Meningitis

Cited by 2 publications

References 16 publications

Reversal of CSF HIV-1 Escape during Treatment of HIV-Associated Cryptococcal Meningitis in Botswana

Reversal of CSF HIV-1 Escape during Treatment of HIV-Associated Cryptococcal Meningitis in Botswana

Human Immunodeficiency Virus in the Brain—Culprit or Facilitator?

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