Cerebrospinal fluid and plasma viral load in HIV-1-infected patients with various anti-retroviral treatment regimens

Highly active anti-retroviral therapy (HAART) effectively decreases HIV-1 R NA in cerebrospinal fluid (CSF) and plasma in controlled clinical trials. T o study the virological effect in CSF and plasma achieved in routine practi ce, HIV-1 RNA levels,were analysed retrospectively in 27 patients on mono-n ucleoside reversed transcriptase inhibitor (NRTI) treatment, 27 on dual-NRT I-treatment and 45 on HAART using a Roche Amplicor HIV-1 monitor quantitati ve PCR. A significant difference was found in the proportion of patients wi th a CSF viral load below 20 copies/ml between patients treated with 1 (0%) and 2 NRTIs (41%) as well as between those treated with 2 NRTIs and HAART (69%). The proportion of patients with plasma viral load below 20 copies/ml differed significantly between patients on HAART (47%) and those on 2 NRTI s (0%), but not between those with 1 (0%) or 2 NRTIs. In multivariate regre ssion analysis, treatment regimen and Drier anti-retroviral experience (but not treatment time) were independently associated with the CSF viral load. Plasma viral load mas independently associated with treatment regimen and treatment time, but not with anti-retroviral experience. Dual-NRTI-treatmen t affects the CSF viral load substantially, while HAART is required to achi eve an essential decline in plasma viral load.