Detectable HIV RNA in Cerebrospinal Fluid: What Does It Mean?

Although combination antiretroviral therapy (ART) has markedly reduced the incidence of HIV-related dementia, some patients continue to have more-subtle neurocognitive dysfunction. Because antiretroviral agents have variable penetration across the blood-brain barrier, there is a lingering concern that viral replication may continue in the central nervous system (CNS) despite suppression in the blood. However, such so-called “CNS escape” has been thought to be rare — and, when detected, has been in patients with neurological symptoms. Now, investigators have assessed the frequency of CNS escape in asymptomatic patients, using archived cerebrospinal fluid (CSF) specimens.

The cross-sectional study involved 69 patients on ART who had undetectab…