Cerebrospinal fluid pleocytosis as a predictive factor for CSF and plasma HIV RNA discordance and escape

• Published in: Journal of neurovirology Vol. 26; no. 2; pp. 241 - 251
• Main Authors: de Almeida, Sérgio Monteiro, Rotta, Indianara, de Pereira, Ana Paula, Tang, Bin, Umlauf, Anya, Ribeiro, Cléa Elisa Lopes, Letendre, Scott, Ellis, Ronald J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2020
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Biomedical and Life Sciences; Biomedicine; Female; HIV Infections - drug therapy; HIV-1; Humans; Immunology; Infectious Diseases; Leukocytosis - cerebrospinal fluid; Male; Middle Aged; Neurology; Neurosciences; RNA, Viral - blood; RNA, Viral - cerebrospinal fluid; Virology; HIV-1; Cerebrospinal fluid (CSF); Central nervous system (CNS); Scape; White blood cell; Discordance
• ISSN: 1355-0284; 1538-2443
• DOI: 10.1007/s13365-020-00828-1

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.