AIDS (London, England) · 2025
Full reservoirs and poor adherence: two cases of symptomatic HIV cerebrospinal fluid escape with tenofovir alafenamide/emtricitabine/bictegravir.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Calcagno Andrea, Lipani Carola, Rizzello Barbara, Mussa Marco, Perinzano Andrea, Angilletta Roberto, Romano Francesca, Bosio Roberta, Allice Tiziano, Calitri Carmelina, Guastamacchia Giulia, Trunfio Mattia, Di Perri Giovanni, Bonora Stefano
Аннотация
BACKGROUND: Symptomatic cerebrospinal fluid (CSF) escape is an uncommon presentation in people with HIV with undetectable or low-level HIV RNA while on combination antiretroviral treatment (cART). Only one case has been reported in a patient receiving bictegravir-based therapy so far.
METHODS: We looked for patients presenting with neurological symptoms while on Tenofovir Alafenamide/Emtricitabine/Bictegravir and who were confirmed to have a CSF HIV RNA above plasma HIV RNA.
RESULTS: One patient presented with confusion and cognitive changes; her plasma and CSF HIV RNA were 486 and 1400 copies/ml. In CSF but not plasma, next-generation sequencing identified resistance-associated mutations (RAMs) to nucleoside reverse transcriptase inhibitors (K70N at 22% and T215S at 92%) and nonnucleoside reverse transcriptase inhibitors (E138K at 18%). One patient presented with lower limb pain and weakness: his plasma and CSF HIV RNA were 7410 and 88 000 copies/ml. No RAMs were found but biomarkers suggested intrathecal immune activation and neuronal damage. Intensification with doravirine led to suppression of plasma viremia within 3 months.
CONCLUSION: This case series suggests that symptomatic CSF escape is possible even with modern cART and that lumbar punctures may be needed in the presence of unexplained neurological/neuropsychological symptoms.
METHODS: We looked for patients presenting with neurological symptoms while on Tenofovir Alafenamide/Emtricitabine/Bictegravir and who were confirmed to have a CSF HIV RNA above plasma HIV RNA.
RESULTS: One patient presented with confusion and cognitive changes; her plasma and CSF HIV RNA were 486 and 1400 copies/ml. In CSF but not plasma, next-generation sequencing identified resistance-associated mutations (RAMs) to nucleoside reverse transcriptase inhibitors (K70N at 22% and T215S at 92%) and nonnucleoside reverse transcriptase inhibitors (E138K at 18%). One patient presented with lower limb pain and weakness: his plasma and CSF HIV RNA were 7410 and 88 000 copies/ml. No RAMs were found but biomarkers suggested intrathecal immune activation and neuronal damage. Intensification with doravirine led to suppression of plasma viremia within 3 months.
CONCLUSION: This case series suggests that symptomatic CSF escape is possible even with modern cART and that lumbar punctures may be needed in the presence of unexplained neurological/neuropsychological symptoms.