Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.

HIV cerebrospinal fluid (CSF) escape is defined by a concentration of HIV-1 RNA in CSF above the lower limit of quantification of the employed assay and equal to or greater than the plasma HIV-1 RNA level in the presence of treatment-related plasma viral suppression, while CSF discordance is similar...

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Autores principales:	Lars Hagberg, Richard W Price, Henrik Zetterberg, Dietmar Fuchs, Magnus Gisslén
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/22544cec33e1421583998eafe3552cc1
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spelling	oai:doaj.org-article:22544cec33e1421583998eafe3552cc12021-12-02T20:18:57ZHerpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.1932-620310.1371/journal.pone.0236162https://doaj.org/article/22544cec33e1421583998eafe3552cc12020-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0236162https://doaj.org/toc/1932-6203HIV cerebrospinal fluid (CSF) escape is defined by a concentration of HIV-1 RNA in CSF above the lower limit of quantification of the employed assay and equal to or greater than the plasma HIV-1 RNA level in the presence of treatment-related plasma viral suppression, while CSF discordance is similarly defined by equal or higher CSF than plasma HIV-1 RNA in untreated individuals. During secondary CSF escape or discordance, disproportionate CSF HIV-1 RNA develops in relation to another infection in addition to HIV-1. We performed a retrospective review of people living with HIV receiving clinical care at Sahlgrenska Infectious Diseases Clinic in Gothenburg, Sweden who developed uncomplicated herpes zoster (HZ) and underwent a research lumbar puncture (LP) within the ensuing 150 days. Based on treatment status and the relationship between CSF and plasma HIV-1 RNA concentrations, they were divided into 4 groups: i) antiretroviral treated with CSF escape (N = 4), ii) treated without CSF escape (N = 5), iii) untreated with CSF discordance (N = 8), and iv) untreated without CSF discordance (N = 8). We augmented these with two additional cases of secondary CSF escape related to neuroborreliosis and HSV-2 encephalitis and analyzed these two non-HZ cases for factors contributing to CSF HIV-1 RNA concentrations. HIV-1 CSF escape and discordance were associated with higher CSF white blood cell (WBC) counts than their non-escape (P = 0.0087) and non-discordant (P = 0.0017) counterparts, and the CSF WBC counts correlated with the CSF HIV-1 RNA levels in both the treated (P = 0.0047) and untreated (P = 0.002) group pairs. Moreover, the CSF WBC counts correlated with the CSF:plasma HIV-1 RNA ratios of the entire group of 27 subjects (P = <0.0001) indicating a strong effect of the CSF WBC count on the relation of the CSF to plasma HIV-1 RNA concentrations across the entire sample set. The inflammatory response to HZ and its augmenting effect on CSF HIV-1 RNA was found up to 5 months after the HZ outbreak in the cross-sectional sample and, was present for one year after HZ in one individual followed longitudinally. We suggest that HZ provides a 'model' of secondary CSF escape and discordance. Likely, the inflammatory response to HZ pathology provoked local HIV-1 production by enhanced trafficking or activation of HIV-1-infected CD4+ T lymphocytes. Whereas treatment and other systemic factors determined the plasma HIV-1 RNA concentrations, in this setting the CSF WBC counts established the relation of the CSF HIV-1 RNA levels to this plasma set-point.Lars HagbergRichard W PriceHenrik ZetterbergDietmar FuchsMagnus GisslénPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 15, Iss 7, p e0236162 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lars Hagberg Richard W Price Henrik Zetterberg Dietmar Fuchs Magnus Gisslén Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.
description	HIV cerebrospinal fluid (CSF) escape is defined by a concentration of HIV-1 RNA in CSF above the lower limit of quantification of the employed assay and equal to or greater than the plasma HIV-1 RNA level in the presence of treatment-related plasma viral suppression, while CSF discordance is similarly defined by equal or higher CSF than plasma HIV-1 RNA in untreated individuals. During secondary CSF escape or discordance, disproportionate CSF HIV-1 RNA develops in relation to another infection in addition to HIV-1. We performed a retrospective review of people living with HIV receiving clinical care at Sahlgrenska Infectious Diseases Clinic in Gothenburg, Sweden who developed uncomplicated herpes zoster (HZ) and underwent a research lumbar puncture (LP) within the ensuing 150 days. Based on treatment status and the relationship between CSF and plasma HIV-1 RNA concentrations, they were divided into 4 groups: i) antiretroviral treated with CSF escape (N = 4), ii) treated without CSF escape (N = 5), iii) untreated with CSF discordance (N = 8), and iv) untreated without CSF discordance (N = 8). We augmented these with two additional cases of secondary CSF escape related to neuroborreliosis and HSV-2 encephalitis and analyzed these two non-HZ cases for factors contributing to CSF HIV-1 RNA concentrations. HIV-1 CSF escape and discordance were associated with higher CSF white blood cell (WBC) counts than their non-escape (P = 0.0087) and non-discordant (P = 0.0017) counterparts, and the CSF WBC counts correlated with the CSF HIV-1 RNA levels in both the treated (P = 0.0047) and untreated (P = 0.002) group pairs. Moreover, the CSF WBC counts correlated with the CSF:plasma HIV-1 RNA ratios of the entire group of 27 subjects (P = <0.0001) indicating a strong effect of the CSF WBC count on the relation of the CSF to plasma HIV-1 RNA concentrations across the entire sample set. The inflammatory response to HZ and its augmenting effect on CSF HIV-1 RNA was found up to 5 months after the HZ outbreak in the cross-sectional sample and, was present for one year after HZ in one individual followed longitudinally. We suggest that HZ provides a 'model' of secondary CSF escape and discordance. Likely, the inflammatory response to HZ pathology provoked local HIV-1 production by enhanced trafficking or activation of HIV-1-infected CD4+ T lymphocytes. Whereas treatment and other systemic factors determined the plasma HIV-1 RNA concentrations, in this setting the CSF WBC counts established the relation of the CSF HIV-1 RNA levels to this plasma set-point.
format	article
author	Lars Hagberg Richard W Price Henrik Zetterberg Dietmar Fuchs Magnus Gisslén
author_facet	Lars Hagberg Richard W Price Henrik Zetterberg Dietmar Fuchs Magnus Gisslén
author_sort	Lars Hagberg
title	Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.
title_short	Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.
title_full	Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.
title_fullStr	Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.
title_full_unstemmed	Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.
title_sort	herpes zoster in hiv-1 infection: the role of csf pleocytosis in secondary csf escape and discordance.
publisher	Public Library of Science (PLoS)
publishDate	2020
url	https://doaj.org/article/22544cec33e1421583998eafe3552cc1
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Herpes zoster in HIV-1 infection: The role of CSF pleocytosis in secondary CSF escape and discordance.

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