cerebrospinal Fluid Hiv Rna and Drug Levels With Combination Ritonavir and Saquinavir

Summary: Combination antiretroviral therapy with ritonavir and saquinavir has established potent and durable activity on plasma viremia. CNS HIV infection may be sequestered from drug therapy that does not penetrate the blood-brain barrier. Penetration of these protease inhibitors into the cerebrospinal fluid (CSF) and CSF HIV RNA levels on such therapy has not been well described. Design/Methods: In a cross-sectional study, 28 HIV-1-infected study subjects were evaluated either before initiation of or before maximal response to ritonavir-saquinavir therapy, during maximal plasma virologic response, and after virologic failure. Simultaneous samples of plasma and cerebrospinal fluid were obtained from 24 study subjects to measure HIV RNA and protease inhibitor levels. Results: Across the treatment groups, a strong correlation was found between plasma and CSF HIV RNA levels (r = 0.870; p Conclusions: CSF ritonavir and saquinavir levels are consistent with the estimated known fraction of unbound drug in plasma (