547. Incidence of symptomatic CSF viral escape in HIV infected adults receiving atazanavir/ritonavir (ATV/r)-containing ART: A tertiary care cohort in western India
Session: Poster Abstract Session: HIV and Central Nervous System
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • CSF escape IDWeek 2017 .pdf (815.2 kB)
  • Background: CSF viral escape (CSF-VE) in patients receiving effective antiretroviral treatment (ART) has been increasingly described in the last decade. This single-center study attempts to quantify the incidence of symptomatic CSF escape in patients receiving ATV/r containing regimen.

    Objectives: Primary objective was to assess the incidence of symptomatic CSF-VE in patients receiving ATV/r-containing ART in clinical practice. Secondary objectives were to describe clinical presentation, risk factors and clinical response after ART was changed.

    Methods: We performed a retrospective analysis of adults receiving ATV/r-containing ART who were diagnosed with symptomatic CSF-VE from August 2013 to January 2017 at a tertiary care center. Patients with active CNS infections were excluded. Incidence rates were calculated by dividing the number of patients who experienced CSF-VE by the number of person-months at risk and summarized as per 10000 (ten thousand) person–months at risk. Difference in incidence of CSF-VE as per the ART regimen was assessed using Fisher exact test.          

    Results:  933 HIV-1 adults with a total of 36,068 person-months of follow up were included.  Of 26 patients diagnosed with CSF-VE, 16 (61.5%) received ATV/r-containing regimens. Impaired memory (56.3%), dizziness (50%) and tremors (43.8%) were the three most common presenting symptoms. Incidence rate of symptomatic CSF-VE was 4.4 per 10,000 person-months (95% CI 2.7 to 7.2). Incidence of CSF-VE was not associated with age, sex, weight, or ART status (na•ve vs first line failure) of the patient. The incidence of CSF-VE was 9.5 per 10,000 person-months (95% CI 5.7 to 15.7) when the nadir CD4 count was ²200 compared to 0.49 (95% CI 0.07 to 3.5) with a nadir CD4 count >200 (IRR 19.1 (95% CI 2.93 to 802.8), p<0.0001) (figure 1). None receiving AZT/3TC developed CSF-VE, while 16 out of 686 receiving TDF/FTC developed CSF-VE (p=0.001). ART was optimized in all patients with a median CPE score of 10.5(7-13). All patients had rapid neurological improvement after change in ART.

    Conclusion: Symptomatic CSF-VE with ATV/r containing regimen was a rare but clinically significant condition in this single-center study. Nadir CD4 count ² 200 was associated with substantially increased risk of symptomatic CSF-VE, further strengthening efforts to diagnose and treat patients early in disease.

    Figure 1:

    Description: Macintosh HD:Users:atulpatel:Desktop:Figure 1 CSF VE.png

    Atul Patel, MD, FIDSA1,2, Ketan Patel, MD2, Swati Gohel, MD2, Ambuj Kumar, M.D., M.P.H1 and Scott Letendre, MD3, (1)Department of Internal Medicine, University of South Florida, Tampa, FL, (2)Infectious Diseases, Vedanta Institute of Medical Sciences, Ahmedabad, India, (3)Medicine, University of California San Diego, La Jolla, CA

    Disclosures:

    A. Patel, None

    K. Patel, None

    S. Gohel, None

    A. Kumar, None

    S. Letendre, None

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