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

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Abstract

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/mm3 than the group with normal CSF WBC count. CSF WBC counts (cut-off of 15 cells/mm3) 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.

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Funding

This research was supported by NIH R21 MH76651 (principal investigators: R. Ellis, S. de Almeida) and HIV Neurobehavioral Research Center (HNRC; P30 MH062512).

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Authors and Affiliations

  1. Virology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil

    Sérgio Monteiro de Almeida & Indianara Rotta

  2. Department of Psychology, Universidade Federal do Paraná, Curitiba, PR, Brazil

    Ana Paula de Pereira

  3. Department of Medicine and Psychiatry, University of California, San Diego, CA, USA

    Bin Tang, Anya Umlauf & Scott Letendre

  4. Infectious Diseases Unity, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil

    Cléa Elisa Lopes Ribeiro

  5. Department of Neurosciences and Psychiatry, University of California, San Diego, CA, USA

    Ronald J. Ellis

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  1. Sérgio Monteiro de Almeida
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  2. Indianara Rotta
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  3. Ana Paula de Pereira
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  4. Bin Tang
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  8. Ronald J. Ellis
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the HIV Neurobehavioral Research Center (HNRC) Group

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Correspondence to Sérgio Monteiro de Almeida.

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de Almeida, S.M., Rotta, I., de Pereira, A.P. et al. Cerebrospinal fluid pleocytosis as a predictive factor for CSF and plasma HIV RNA discordance and escape. J. Neurovirol. 26, 241–251 (2020). https://doi.org/10.1007/s13365-020-00828-1

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