Relationship of Human Immunodeficiency Virus Viral Load in Cerebrospinal Fluid and Plasma in Patients Co-infected With Cryptococcal Meningitis

Christina C Chang; Richard Kangethe; Saleha Omarjee; Keshni Hiramen; Bernadett Gosnell; Katlego Sojane; Mohamed-Yunus S Moosa; Sharon R Lewin; Martyn A French; Thumbi Ndung'u

doi:10.1093/ofid/ofx032

Relationship of Human Immunodeficiency Virus Viral Load in Cerebrospinal Fluid and Plasma in Patients Co-infected With Cryptococcal Meningitis

Open Forum Infect Dis. 2017 Feb 12;4(2):ofx032. doi: 10.1093/ofid/ofx032. eCollection 2017 Spring.

Authors

Christina C Chang^{1

2}, Richard Kangethe², Saleha Omarjee², Keshni Hiramen², Bernadett Gosnell³, Katlego Sojane², Mohamed-Yunus S Moosa³, Sharon R Lewin^{1

4}, Martyn A French^{5

6}, Thumbi Ndung'u^{2

7

8

9}

Affiliations

¹ Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia.
² HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal (UKZN), Durban, South Africa.
³ Department of Infectious Diseases, King Edward VIII Hospital, UKZN, Durban, South Africa.
⁴ The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Australia.
⁵ Department of Clinical Immunology, Royal Perth Hospital and PathWest Laboratory Medicine, Australia.
⁶ School of Pathology and Laboratory Medicine, University of Western Australia, Perth.
⁷ Africa Health Research Institute, Nelson R Mandela School of Medicine, UKZN, Durban, South Africa.
⁸ Ragon Institute of MGH, MIT and Harvard University, Cambridge, Massachussetts.
⁹ Max Planck Institute for Infection Biology, Chariteplatz, Berlin, Germany.

Abstract

We measured human immunodeficiency virus (HIV) ribonucleic acid (RNA) in paired cerebrospinal fluid (CSF) and plasma samples in a prospective study of 91 HIV-infected, antiretroviral therapy-naive patients with cryptococcal meningitis. Cerebrospinal fluid HIV RNA was lower than in plasma (median 4.7 vs 5.2 log₁₀ copies/mL, P < .0001) and positively correlated with plasma HIV RNA, peripheral CD4⁺ T-cell percentage, and CSF CXCL10. Plasma/CSF ratio of HIV RNA ranged widely from 0.2 to 265.5 with a median of 2.6. Cerebrospinal fluid quantitative cryptococcal culture positively correlated with CSF CCL2 and CCL3. CSF-plasma viral discordance was not associated with cryptococcal-associated immune reconstitution inflammatory syndrome.

Keywords: HIV.; cerebrospinal fluid; cryptococcal meningitis.