High concordance in plasma and CSF HIV-1 drug resistance mutations despite high cases of CSF viral escape in individuals with HIV-associated cryptococcal meningitis in Botswana

Journal of Antimicrobial Chemotherapy

In Botswana, a recent research study investigated how well the HIV virus and drug resistance mutations behave in the blood and cerebrospinal fluid (CSF) of individuals with HIV-associated cryptococcal meningitis. Cryptococcal meningitis is a severe infection of the brain and spinal cord that primarily affects people living with HIV. The researchers were particularly interested in understanding whether drug resistance mutations in the HIV virus were present in both the blood and CSF and how these mutations might impact the effectiveness of antiretroviral therapy (ART) – the treatment for HIV.

They found that despite some individuals experiencing viral escape (a situation where the virus replicates HIGHER IN one compartment than the Other), the drug resistance mutations were remarkably consistent between the blood and CSF samples. This means that the same drug-resistant forms of the virus were present in both compartments, suggesting that treatment responses in the blood may generally reflect what’s happening in the CSF.

However, the researchers also observed that many individuals with cryptococcal meningitis showed high cases of CSF viral escape. This finding is concerning because it suggests that the virus can still persist in the central nervous system despite treatment.

The study’s results highlight the importance of closely monitoring both the blood and CSF of individuals with HIV-associated cryptococcal meningitis to ensure that appropriate antiretroviral therapies are given to prevent viral escape and reduce the likelihood of developing drug resistance. Further research is needed to better understand the factors contributing to viral escape in the CSF and to develop more effective treatment strategies to manage this challenging condition in Botswana and other regions affected by HIV and cryptococcal meningitis.

SANTHE is an Africa Health Research Institute (AHRI) flagship programme funded by the Science for Africa Foundation through the DELTAS Africa programme; the Bill & Melinda Gates Foundation; Gilead Sciences Inc.; and the Ragon Institute of Mass General, MIT, and Harvard.