Reversal of CSF HIV-1 Escape during Treatment of HIV-Associated Cryptococcal Meningitis in Botswana.

Autor:	Kelentse N; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana., Moyo S; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA., Molebatsi K; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana., Morerinyane O; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Bitsang S; Botswana-University of Maryland School of Medicine Health Initiative, Gaborone, Botswana., Bareng OT; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana., Lechiile K; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Leeme TB; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana., Lawrence DS; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Kasvosve I; Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana., Musonda R; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA., Mosepele M; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana., Harrison TS; Centre for Global Health, Institute for Infection and Immunity, St. George's University of London, London SW17 0RE, UK., Jarvis JN; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK., Gaseitsiwe S; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Jazyk:	angličtina
Zdroj:	Biomedicines [Biomedicines] 2022 Jun 13; Vol. 10 (6). Date of Electronic Publication: 2022 Jun 13.
DOI:	10.3390/biomedicines10061399
Abstrakt:	Cerebrospinal fluid (CSF) viral escape has been poorly described among people with HIV-associated cryptococcal meningitis. We determined the prevalence of CSF viral escape and HIV-1 viral load (VL) trajectories in individuals treated for HIV-associated cryptococcal meningitis. A retrospective longitudinal study was performed using paired CSF and plasma collected prior to and during the antifungal treatment of 83 participants recruited at the Botswana site of the phase-3 AMBITION-cm trial (2018−2021). HIV-1 RNA levels were quantified then CSF viral escape (CSF HIV-1 RNA ≥ 0.5 log10 higher than plasma) and HIV-1 VL trajectories were assessed. CSF viral escape occurred in 20/62 (32.3%; 95% confidence interval [CI]: 21.9−44.6%), 13/52 (25.0%; 95% CI: 15.2−38.2%) and 1/33 (3.0%; 95% CI: 0.16−15.3%) participants at days 1, 7 and 14 respectively. CSF viral escape was significantly lower on day 14 compared to days 1 and 7, p = 0.003 and p = 0.02, respectively. HIV-1 VL decreased significantly from day 1 to day 14 post antifungal therapy in the CSF but not in the plasma (β = −0.47; 95% CI: −0.69 to −0.25; p < 0.001). CSF viral escape is high among individuals presenting with HIV-associated cryptococcal meningitis; however, antifungal therapy may reverse this, highlighting the importance of rapid initiation of antifungal therapy in these patients.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu