Several aspects concerning the diagnosis and treatment of HIV-associated lesions in the central nervous system during antiretroviral therapy
Authors:   Infectious Diseases Clinical Hospital No. 2, Moscow, Russian Federation, Smirnov N.A. , Nagibina M.V. ,   Russian University of Medicine, Moscow, Russian Federation, Martynova N.N. ,   Infectious Diseases Clinical Hospital No. 2, Moscow, Russian Federation, Bessarab T.P. ,   Infectious Diseases Clinical Hospital No. 2, Moscow, Russian Federation, Mazus A.I. ,   Infectious Diseases Clinical Hospital No. 2, Moscow, Russian Federation, Sidoruk L.M. ,   Infectious Diseases Clinical Hospital No. 2, Moscow, Russian Federation, Kulagina M.G. ,   Russian University of Medicine, Moscow, Russian Federation
Published: January 2025

Background: current epidemiological data indicates that neurocognitive disorders linked to human immunodeficiency virus (HIV) infection
have a prevalence as high as 23.5%. The establishment of a latent HIV reservoir within the central nervous system (CNS) is implicated in the
pathogenesis of HIV-related neurocognitive lesions, both prior to and during antiretroviral therapy (ART).
Aim: this study aims to investigate the etiological factors contributing to CNS damage associated with HIV in patients receiving ART.
Materials and Methods: the study examines the clinical and laboratory results from a cohort of 12 HIV-positive patients presenting with
secondary diseases in a progressive phase during ART. The sample includes patients exhibiting signs of meningoencephalitis of unspecified
etiology, with five patients undergoing comprehensive evaluation.
Results: the mean age of the study cohort was 40.3±4.1 years, with a female predominance of 67% (8 out of 12 patients). The median
duration of HIV infection was 10.9±7.1 years. Analysis of data from five evaluated patients revealed suboptimal ART efficacy sustained
over more than three years, as evidenced by persistent serum HIV RNA levels (2796.6±2393.12 cp/mL) and diminished CD4+ lymphocyte
counts (257.8±126.24 cells/μL). Cerebrospinal fluid (CSF) analyses, utilizing bacteriological and PCR methodologies, ruled out opportunistic
infections but demonstrated elevated HIV RNA concentrations (31,068.2±23,694.92 cp/mL), surpassing blood levels by 4.071±0.514 log10
(approximately an 11-fold increase). Brain MRI displayed multiple sites of hyperintensity without well-defined borders across various cerebral
regions, leading to a diagnosis of HIV-associated meningoencephalitis. Post-intervention with modified ART regimens and CNS-penetrant
pharmaceuticals, all patients exhibited regression of neurological symptoms and improvements on subsequent CSF analyses and brain MRI.
Conclusion: in HIV-infected patients with pronounced neurological manifestations and inconclusive etiological diagnostics, quantification of
HIV RNA in the CSF is recommended to elucidate the underlying cause of CNS damage, permitting targeted adjustments in ART tactics.
KEYWORDS: HIV infection, meningoencephalitis, antiretroviral therapy, spinal fluid, HIV viral load.
FOR CITATION: Smirnov N.A., Nagibina M.V., Martynova N.N., Bessarab T.P., Mazus A.I., Sidoruk L.M., Kulagina M.G. Several aspects
concerning the diagnosis and treatment of HIV-associated lesions in the central nervous system during antiretroviral therapy. Russian
Medical Inquiry. 2024;8(11):667–673 (in Russ.). DOI: 10.32364/2587-6821-2024-8-11-10