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Objective:

To characterize HIV-infected patients with neurosymptomatic cerebrospinal fluid (CSF)‘escape’, defined as detectable CSF HIV RNA in the setting of treatment-suppressed plasma levels or CSF RNA more than 1-log higher than plasma RNA.

Design:

Retrospective case series.

Setting:

Four urban medical centers in the United States and Europe.

Participants:

Virologically controlled HIV-infected patients on antiretroviral therapy (ART) with progressive neurologic abnormalities who were determined to have CSF ‘escape’.

Intervention:

Optimization of ART based upon drug susceptibility and presumed central nervous system exposure.

Main outcome measures:

Levels of CSF HIV RNA and inflammatory markers, clinical signs and symptoms, and MRI findings.

Results:

Ten patients presented with new neurologic abnormalities, which included sensory, motor, and cognitive manifestations. Median CSF HIV RNA was …