ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2018
Impact of Antiretroviral Regimens on Cerebrospinal Fluid Viral Escape in a Prospective Multicohort Study of Antiretroviral Therapy-Experienced Human Immunodeficiency Virus-1-Infected Adults in the United States.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers.
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Who cites it
46 citing papers in PubMed, 76 citations in OpenAlex.
- High concordance in plasma and CSF HIV-1 drug resistance mutations despite high cases of CSF viral escape in individuals with HIV-associated cryptococcal meningitis in Botswana.The Journal of antimicrobial chemotherapy · 2022Trial
- Persistent low-level viremia and symptomatic HIV cerebrospinal fluid escape in a person living with HIV receiving darunavir: a case report.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases · 2026Article
- HIV Reservoirs in Brain parenchyma and Cerebrospinal Fluid During Suppressive ART: Same-Same or Very Different?Current HIV/AIDS reports · 2026Review
- Central Nervous System HIV Persistence and Clinical Consequences During Suppressive ART.Current HIV/AIDS reports · 2026Review
- Viral infection states, immune control, and adult cognition: evidence across latency, persistence, and post-acute responses.Frontiers in immunology · 2026Review
- Article
- Cannabis use is associated with a lower likelihood of presence of HIV drug resistance mutations in a retrospective cohort of adults with HIV.NeuroImmune pharmacology and therapeutics · 2025Article
- Asymptomatic Cerebrospinal Fluid HIV-1 Escape: Incidence and Consequences.The Journal of infectious diseases · 2025Article
- HIV Cerebrospinal Fluid Escape: Interventions for the Management, Current Evidence and Future Perspectives.Tropical medicine and infectious disease · 2025Review
- The incidence of symptomatic CSF viral escape in patients on antiretroviral therapy in western India: a retrospective cohort study.Journal of neurovirology · 2025Article
- Neurosymptomatic HIV-1 CSF escape is associated with replication in CNS T cells and inflammation.The Journal of clinical investigation · 2024Article
- Changes in cerebrospinal fluid proteins across the spectrum of untreated and treated chronic HIV-1 infection.PLoS pathogens · 2024Article
- Darunavir Nanoformulation Suppresses HIV Pathogenesis in Macrophages and Improves Drug Delivery to the Brain in Mice.Pharmaceutics · 2024Article
- Longitudinal analysis of CSF HIV RNA in untreated people with HIV: Identification of CSF controllers.Journal of medical virology · 2024Article
- Differences in drug resistance of HIV-1 genotypes in CSF and plasma and analysis of related factors.Virulence · 2023Article
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- Biotypes of Central Nervous System Complications in People With Human Immunodeficiency Virus: Virology, Immunology, and Neuropathology.The Journal of infectious diseases · 2023Article
- Clinical Reasoning: Rapidly Progressive Dementia in a Man With HIV Infection and Undetectable Plasma Viral Load.Neurology · 2023Article
- Antiretroviral drugs efavirenz, dolutegravir and bictegravir dysregulate blood-brain barrier integrity and function.Frontiers in pharmacology · 2023Article
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
Background: Cerebrospinal fluid (CSF) viral escape occurs in 4%-20% of human immunodeficiency virus (HIV)-infected adults, yet the impact of antiretroviral therapy (ART) on CSF escape is unclear. Methods: A prospective study of 1063 participants with baseline plasma viral load (VL) ≤400 copies/mL between 2005 and 2016. The odds ratio (OR) for ART regimens (protease inhibitor with nucleoside reverse transcriptase inhibitor [PI + NRTI] vs other ART) and CSF escape was estimated using mixed-effects models. Results: Baseline mean age was 46 years, median plasma VL, and CD4 count were 50 copies/mL, and 424 cells/μL, respectively. During median follow-up of 4.4 years, CSF escape occurred in 77 participants (7.2%). PI + NRTI use was an independent predictor of CSF escape (OR, 3.1; 95% confidence interval, 1.8-5.0) in adjusted analyses and models restricted to plasma VL ≤50 copies/mL (P < .001). Regimens that contained atazanavir (ATV) were a stronger predictor of CSF viral escape than non-ATV PI + NRTI regimens. Plasma and CSF M184V/I combined with thymidine-analog mutations were more frequent in CSF escape vs no escape (23% vs 2.3%). Genotypic susceptibility score-adjusted central nervous system (CNS) penetration-effectiveness (CPE) values were calculated for CSF escape with M184V/I mutations (n = 34). Adjusted CPE values were low (<5) for CSF in 27 (79%), indicating suboptimal CNS drug availability. Conclusions: PI + NRTI regimens are independent predictors of CSF escape in HIV-infected adults. Reduced CNS ART bioavailability may predispose to CSF escape in patients with M184V/I mutations.
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