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(NIHR)","award":["RP-2017-08-ST2-012"],"award-info":[{"award-number":["RP-2017-08-ST2-012"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomedicines"],"abstract":"<jats:p>Cerebrospinal fluid (CSF) viral escape has been poorly described among people with HIV-associated cryptococcal meningitis. We determined the prevalence of CSF viral escape and HIV-1 viral load (VL) trajectories in individuals treated for HIV-associated cryptococcal meningitis. A retrospective longitudinal study was performed using paired CSF and plasma collected prior to and during the antifungal treatment of 83 participants recruited at the Botswana site of the phase-3 AMBITION-cm trial (2018\u20132021). HIV-1 RNA levels were quantified then CSF viral escape (CSF HIV-1 RNA \u2265 0.5 log10 higher than plasma) and HIV-1 VL trajectories were assessed. CSF viral escape occurred in 20\/62 (32.3%; 95% confidence interval [CI]: 21.9\u201344.6%), 13\/52 (25.0%; 95% CI: 15.2\u201338.2%) and 1\/33 (3.0%; 95% CI: 0.16\u201315.3%) participants at days 1, 7 and 14 respectively. CSF viral escape was significantly lower on day 14 compared to days 1 and 7, p = 0.003 and p = 0.02, respectively. HIV-1 VL decreased significantly from day 1 to day 14 post antifungal therapy in the CSF but not in the plasma (\u03b2 = \u22120.47; 95% CI: \u22120.69 to \u22120.25; p &lt; 0.001). CSF viral escape is high among individuals presenting with HIV-associated cryptococcal meningitis; however, antifungal therapy may reverse this, highlighting the importance of rapid initiation of antifungal therapy in these patients.<\/jats:p>","DOI":"10.3390\/biomedicines10061399","type":"journal-article","created":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T22:00:38Z","timestamp":1655157638000},"page":"1399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Reversal of CSF HIV-1 Escape during Treatment of HIV-Associated Cryptococcal Meningitis in Botswana"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2433-2416","authenticated-orcid":false,"given":"Nametso","family":"Kelentse","sequence":"first","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-4592","authenticated-orcid":false,"given":"Sikhulile","family":"Moyo","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kesaobaka","family":"Molebatsi","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olorato","family":"Morerinyane","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shatho","family":"Bitsang","sequence":"additional","affiliation":[{"name":"Botswana-University of Maryland School of Medicine Health Initiative, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ontlametse T.","family":"Bareng","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwana","family":"Lechiile","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tshepo B.","family":"Leeme","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5439-4039","authenticated-orcid":false,"given":"David S.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2046-545X","authenticated-orcid":false,"given":"Ishmael","family":"Kasvosve","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosemary","family":"Musonda","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mosepele","family":"Mosepele","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas S.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Centre for Global Health, Institute for Infection and Immunity, St. George\u2019s University of London, London SW17 0RE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph N.","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Clinical Research, Faculty of Infectious and Tropical Diseases, The London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simani","family":"Gaseitsiwe","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana"},{"name":"Department of Immunology and Infectious Diseases, Harvard T.H. 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