Symptomatic cerebrospinal fluid HIV-1 escape with no resistance-associated mutations following low-level plasma viremia

J Neurovirol. 2018 Feb;24(1):132-136. doi: 10.1007/s13365-017-0605-1. Epub 2017 Dec 14.


The majority of neurologically symptomatic cerebrospinal fluid HIV-1 escape cases are connected with resistance-associated mutations and potentially explained by low cerebrospinal fluid antiretroviral concentrations. However, there are still significant knowledge gaps regarding the physiopathology and long-term management of neurosymptomatic viral escape. We report a case of Parkinson-like syndrome following cerebrospinal fluid HIV-1 escape in a 40-year-old female patient with an history of persistent low-level plasma viremia under treatment. No resistance-associated mutations, high viral diversity (env deep sequencing), adequate pharmacokinetics, atypical CD3-CD14-CD4+CD5-CD2-/+CD7-/+ lymphocytes, low-level Epstein-Barr virus replication, and white matter autoimmune reactivity were observed in the cerebrospinal fluid. Antiretroviral regimen modification led to rapid clinical and radiological improvements. This case may increase the current uncertain knowledge on the origin of cerebrospinal fluid HIV-1 and illustrates the consequences of uncontrolled compartmental viral replication; it also highlights the relevance and persistence of immune activation and the possibility of various detrimental mechanisms underlying neurosymptomatic viral escape.

Keywords: Antiretrovirals; HIV; Neuroimmunology; Viral escape; Virology.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • Drug Substitution
  • Epstein-Barr Virus Infections / cerebrospinal fluid
  • Epstein-Barr Virus Infections / complications
  • Epstein-Barr Virus Infections / drug therapy
  • Epstein-Barr Virus Infections / virology*
  • Female
  • HIV Infections / cerebrospinal fluid
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / virology*
  • HIV-1 / drug effects
  • HIV-1 / genetics
  • HIV-1 / growth & development
  • HIV-1 / pathogenicity
  • Herpesvirus 4, Human / drug effects
  • Herpesvirus 4, Human / growth & development
  • Herpesvirus 4, Human / pathogenicity
  • Humans
  • Parkinson Disease / cerebrospinal fluid
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy
  • Parkinson Disease / virology*
  • RNA, Viral / genetics*
  • Supranuclear Palsy, Progressive / cerebrospinal fluid
  • Supranuclear Palsy, Progressive / complications
  • Supranuclear Palsy, Progressive / drug therapy
  • Supranuclear Palsy, Progressive / virology*
  • Viremia / cerebrospinal fluid
  • Viremia / complications
  • Viremia / drug therapy
  • Viremia / virology*
  • Virus Replication / drug effects


  • Anti-HIV Agents
  • RNA, Viral

Supplementary concepts

  • Progressive supranuclear palsy atypical