CSF viral escape on HAART: Analysis from single tertiary care centre.

HIV infected individuals receiving regular antiretroviral therapy (ART) can present with a high viral load in cerebrospinal fluid (CSF) at time when it is suppressed in blood. This study presents data of HIV infected patients who had undetectable or low plasma viral load in blood but presented with neurological signs and symptoms and were diagnosed to have CSF HIV viral escape. Records were reviewed for clinical manifestations, details of opportunistic or coinfection, HIV viral copies in plasma and CSF at time of diagnosis of CSF escape. A total of 10,200 HIV infected individuals were registered in HIV care till 31 December 2021. Nineteen individuals (14 virologically confirmed & 5 clinically) were diagnosed with high viral copies in CSF from June 2014- December 2021. Mean age was 41.5 ± 9.2 (median, 39.5; range, 30-62) years. Average duration of antiretroviral treatment received at time of diagnosis of CSF escape was 10.1 years. Median plasma HIV-viral copies were 2469.8 (undetectable to 29418) and in CSF were 12773.7 (n=14, Range, 1340-48530) copies/ml. HIV viral copies in CSF were significantly higher than in plasma at the time of presentation (p=0.003). ART regimen switch was done after identification of HIV CSF escape. Seventeen patients were alive with a regular follow-up of average 35 (range 7- 66) months. All had documented clinical improvement with reversal of neurological impairment after ART switch. There was one death and one lost to follow-up. Early identification and timely intervention in CSF viral escape could revert severe neurological impairment and improves treatment outcome.  .