Arenas-Pinto, A;
Stöhr, W;
Clarke, A;
Williams, I;
Beeching, NJ;
Minton, J;
Lee, V;
(2017)
Evaluation of CSF virological escape in patients on long-term PI monotherapy.
Antiviral Therapy
, 22
pp. 535-538.
10.3851/IMP3146.
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Abstract
BACKGROUND: A strategy of protease inhibitor (PI) monotherapy with re-introduction of triple therapy in those who rebound has been shown to be a safe and effective treatment simplification approach for long-term management. We sought evidence for cerebrospinal fluid (CSF) virological escape in patients on long-term PI monotherapy. METHODS: We performed lumbar puncture in asymptomatic participants with suppressed plasma HIV-RNA after 96 weeks on the PI monotherapy arm (PI-mono) of the PIVOT trial. We also report CSF HIV-RNA concentration in trial participants who were investigated for neurological/neurocognitive symptoms during the trial regardless of study arm allocation. RESULTS: All 11 asymptomatic participants on PI-mono who were tested had undetectable CSF HIV-RNA at week 96. One of the 3 symptomatic participants on PI-mono had CSF HIV-RNA of 1895 copies/mL (undetectable in plasma), and neither of 2 symptomatic participants on triple therapy had CSF HIV-RNA detected. CONCLUSIONS: CSF virological escape appears rare in asymptomatic patients on PI monotherapy and may not warrant routine CSF monitoring, but patients with symptoms merit more concern.
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