Table 2.
Factors Associated With First Cerebrospinal Fluid (CSF) Viral Escape or Last Paired CSF-Plasma Viral Load Visit
| Characteristic | CSF Viral Escape (n = 77) | No CSF Viral Escape (n = 986) | P Value |
|---|---|---|---|
| HIV disease characteristics, median (IQR) | |||
| Plasma viral load (copies/mL) | 50 (40, 115.50) | 50 (40, 50) | .24 |
| Nadir CD4+ T-cell count (cells/µL) | 46 (4, 180) | 94 (15, 203) | <.01 |
| CD4+ T-cell count (cells/µL) | 394 (220, 578) | 497.5 (311, 715) | <.01 |
| CD4/CD8 ratio | 0.44 (0.25, 0.71) | 0.62 (0.36, 0.91) | .01 |
| CSF studies, median (IQR) | |||
| Viral load (copies/mL) | 300 (141, 1780) | 50 (40, 50) | <.01 |
| White blood cell count (cells/µL) | 5 (2, 13) | 2 (1, 3) | <.01 |
| Protein (mg/dL) | 45 (36, 57) | 38 (29, 49) | <.01 |
| No. CSF viral load analyses/subject, median (IQR)a | 5 (3, 9) | 4 (2, 6) | <.01 |
| Neurocognitive status,b n (%) | .01 | ||
| Symptomatic neurocognitive impairment | 27 (35.1) | 198 (20.4) | … |
| HIV-associated dementia | 7 (9.1) | 52 (5.4) | … |
| Mild neurocognitive disorder | 13 (17.1) | 99 (10.2) | … |
| Neuropsychiatric impairment–other | 7 (9.1) | 47 (4.8) | … |
| Asymptomatic neurocognitive impairment | 17 (22.1) | 297 (30.6) | … |
| Neurocognitively unimpaired | 33 (42.9) | 475 (49.0) | … |
| ART Regimens, n (%) | |||
| PI + NRTIs | 51 (66.2) | 464 (47.1) | <.01 |
| Other ART | 20 (26.0) | 491 (49.8) | … |
| Integrase inhibitor + NRTIs | 3 (3.9) | 153 (15.5) | … |
| NNRTI + NRTIs | 13 (16.9) | 287 (29.1) | … |
| PI + NNRTI + NRTIs | 4 (5.2) | 51 (5.2) | … |
| Monotherapy/nonstandard therapyc | 4 (5.2) | 17 (1.7) | … |
| Specific drugs in regimen | |||
| Atazanavir | 27 (35.1) | 226 (22.9) | .02 |
| Lopinavir | 9 (11.7) | 135 (13.7) | .75 |
| Darunavir | 10 (13.0) | 143 (14.5) | .84 |
| Efavirenz | 13 (16.9) | 224 (22.7) | .3 |
| Abacavir | 16 (20.8) | 221 (22.4) | .85 |
| Central nervous system penetration-effectiveness value (mean (SD)) | 7.7 (2.1) | 7.9 (1.8) | .3 |
Bold indicates significant after Bonferroni correction (P ≤ .01).
Abbreviations: ART, antiretroviral therapy; CSF, cerebrospinal fluid; HIV, human immunodeficiency virus; IQR, interquartile range; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; SD, standard deviation.
aNumber of CSF analyses performed during follow-up.
bNearest available neurocognitive status (n = 1047; 98.5% cohort). Two-way analysis of variance comparing symptomatic neurocognitive impairment, asymptomatic neurocognitive impairment, and neurocognitively unimpaired.
cNonstandard therapy; regimen inconsistent with 2 NRTIs in combination with a third active ART drug from another class.