Cerebrospinal Fluid Viral Escape and Acute Encephalitis in a Patient on Boosted Protease Inhibitor Monotherapy

Tiraboschi, Juan; Hamzah, Lisa; Siddiqui, Ata; Kulasegaram, Ranjababu; Post, Frank A.; Fox, Julie

doi:10.3851/imp3021

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…The median age of PLHIV diagnosed with CSF HIV escape was 43 years (range: ). This study involved 21 case reports 11,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]30,31,33,38 and six case series. 29,[33][34][35][36][37] Sixteen (80%) of case reports were from Europe, followed by USA (three cases) and India (one case).…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

Cerebrospinal fluid viral escape in HIV patients on antiretroviral therapy: A systematic review of reported cases

Nyondo,

Njiro,

Bwire

2024

Reviews in Medical Virology

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Cerebrospinal fluid (CSF) viral escape rarely occurs when HIV is detected in the CSF, while it is undetectable in the blood plasma or detectable in CSF at levels that exceed those in the blood plasma. We conducted this review to comprehensively synthesise its clinical presentation, diagnosis, management strategies and treatment outcomes. A review registered with PROSPERO (CRD42023475311) searched evidence across PubMed/MEDLINE, Embase, Web of Science, Scopus, and Google Scholar to gather articles (case reports/series) that report on CSF viral escape in people living with HIV (PLHIV) on antiretroviral therapy (ART). The quality of studies was assessed based on the domains of selection, ascertainment, causality, and reporting. A systematic search identified 493 articles and 27 studies that include 21 case reports, and six case series were involved in the review. The studies reported 62 cases of CSF viral escape in PLHIV. The majority were men (66.67%), with a median age of 43 (range: 28–73) years. Approximately, 31 distinct symptoms were documented, mostly being cognitive dysfunction, gait abnormalities, and tremors (12.51%). Diagnosis involved blood and CSF analysis, magnetic resonance imaging, and neuropsychological assessments. Over 36 ART regimens were employed, with a focus on ART intensification; almost one‐third of the regimens contained Raltegravir (integrase strand transfer inhibitor). The outcomes showed 64.49% full recovery, 30.16% partial recovery, and 4.76% died. When neuropsychological symptoms manifest in PLHIV, monitoring for CSF viral escape is essential, regardless of plasma viral suppression. Personalised treatment strategies, particularly ART intensification, are strongly advised for optimising treatment outcomes in PLHIV diagnosed with CSF HIV escape.

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Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

Cerebrospinal fluid viral escape in HIV patients on antiretroviral therapy: A systematic review of reported cases

Nyondo,

Njiro,

Bwire

2024

Reviews in Medical Virology

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“…On the other hand, the cons of dual regimens are possible increased virological failure and drug resistance. Additionally, viral escape is an important risk of suboptimal ART exposure [31][32][33]: triple therapies are the best therapeutic choice for adequate tissue penetrance and distribution of antiretroviral drugs, suppressing HIV replication. Regarding patients switching from triple to dual therapies, a longer follow-up to ensure viral escape is warranted.…”

Section: Introductionmentioning

confidence: 99%

Studying the Changes in Physical Functioning and Oxidative Stress-Related Molecules in People Living with HIV after Switching from Triple to Dual Therapy

Cusato,

Mulasso,

Ferrara

et al. 2024

Antioxidants

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Background: Physical activity could increase the production of oxidative stress biomarkers, affecting the metabolism and excretion of antiretroviral drugs and, consequently, the clinical outcome. Nowadays, people living with HIV (PLWH) are mostly switching from triple to dual therapy, but no data are available in terms of physical functioning and oxidative stress. The aim of this study was to evaluate if some antioxidant biomarkers and physical functioning tests could be different according to triple or dual antiretroviral therapy. Methods: PLWH were evaluated at baseline (BL), while treated with three drugs, and six months after the switch to dual therapy. Physical functioning was quantified using validated tools. Mitochondrial and cytosol antioxidant molecules were evaluated through liquid chromatography. Results: Twenty-five patients were analyzed. A statistically significant difference between triple and dual therapy was found for mitochondrial glutathione, but not for physical tests. Evaluating differences between physically active and inactive individuals, the following statistically significant differences were suggested, considering triple therapy (mitochondrial n-formyl-methionine p = 0.022, triglycerides p = 0.023) and double therapy (mitochondrial glycine p = 0.035, cytosol glutamic acid p = 0.007, cytosol s-adenosylmethionine p = 0.021). Conclusions: For the first time, this study suggests possible differences in terms of antioxidant molecules and physical functioning in PLWH switching from triple to dual therapy.

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Treating HIV Infection in the Central Nervous System

Calcagno

Perri

Bonora

2017

Drugs

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Combination antiretroviral treatment is associated with clear benefits in HIV-positive subjects, and is also effective in the central nervous system (CNS), meaning HIV-associated dementia is now an uncommon event. Nevertheless, a significant number of patients show symptoms of neurocognitive impairment which may negatively affect their quality of life. Although several risk factors for HIV-associated neurocognitive disorders have been identified, there is no clear recommendation for their prevention and management. In this review, the penetration of drugs into the cerebrospinal fluid/CNS is discussed as well as the viral and clinical consequences associated with higher/lower compartmental exposure. We also review the potential interventions according to the currently identified underlying mechanisms, including persistent CNS immune activation, legacy effects, low-level viral replication and escape, co-morbidities, and antiretroviral-associated direct and indirect 'neurotoxicity'. Adjunctive therapies and interventions (including neuro-rehabilitation) are then briefly discussed. The treatment of HIV infection in the CNS is a complex area of therapeutics requiring multidisciplinary interventions and further study.

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Cerebrospinal Fluid Viral Escape and Acute Encephalitis in a Patient on Boosted Protease Inhibitor Monotherapy

Cited by 5 publications

References 12 publications

Cerebrospinal fluid viral escape in HIV patients on antiretroviral therapy: A systematic review of reported cases

Cerebrospinal fluid viral escape in HIV patients on antiretroviral therapy: A systematic review of reported cases

Studying the Changes in Physical Functioning and Oxidative Stress-Related Molecules in People Living with HIV after Switching from Triple to Dual Therapy

Treating HIV Infection in the Central Nervous System

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