Important note: Information in this article was accurate in August 2001. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, August 6, 2001
Michael Greer, Staff Medical Writer
NewsRx - Planned treatment interruptions after failed antiretroviral therapy for HIV infection can lead to an increase in the cerebrospinal fluid (CSF) viral population, researchers in California claim.
"Structured antiretroviral treatment interruption (STI) has been advocated as a therapeutic strategy for HIV 1 infection," in part to limit the development of drug-resistant viral strains, explained Richard W. Price and colleagues at the University of California at San Francisco and other institutions, including ViroLogic, Inc.
After a preliminary study, Price and coworkers found that while STIs led to a more drug-sensitive viral population, the interruptions also resulted in higher CSF viral loads and lymphocyte levels.
The researchers studied five patients during an STI prompted by insufficient viral control during antiretroviral therapy. In four of these patients, CSF samples taken during serial lumbar punctures showed that the CSF viral loads increased markedly faster than plasma viral loads, study data showed.
Viral populations in all patients underwent phenotypic and genotypic changes associated with increased drug susceptibility, Price and team said. These changes in the dominant viral strains were seen simultaneously in both plasma and CSF.
Three of the five participants had highly elevated CSF white blood cell counts during their drug holiday although no neurological symptoms were seen ("Cerebrospinal fluid response to structured treatment interruption after virological failure," AIDS 2001 Jul 6;15(10):1251-9.
"STI may be accompanied by previously unrecognized changes in tissue viral exposures and lymphocyte traffic," Price and colleagues concluded. "Hence, despite 'virological failure' as evidenced by persistent plasma viremia, ongoing antiretroviral treatment prior to its interruption appeared to suppress CSF HIV-1 infection (indeed more effectively than that of plasma) and restrain lymphocyte traffic into the CSF."
The corresponding author for this report is Richard W. Price, Dept. of Neurology, University of California at San Francisco, CA, USA.
Key points reported in this study include:
This article was prepared by AIDS Weekly editors from staff and other reports.
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