Cerebrospinal fluid analysis in human immunodeficiency virus infection.
Cerebrospinal fluid (CSF) analytes were evaluated in 59 human immunodeficiency virus (HIV+) individuals to assess neurological involvement. Glucose, total protein, cell counts, p24 antigen, CSF: serum albumin/IgG ratios, and oligoclonal bands were measured. Eighty percent of samples showed abnormalities in one or more analyte. In some patients samples, these abnormalities could mimic those of secondary opportunistic infection when none was present. The presence of oligoclonal banding in CSF (31 percent) and disturbances in CSF: serum albumin/IgG ratio (30 percent) were related to decreases in serum CD4+ lymphocytes. Disturbances in CSF: Serum albumin/IgG ratio were also related to severity of non-neurological HIV disease staging. Cerebrospinal fluid oligoclonal bands were distinct from that found in serum in the same subjects. Since immune complexes between immunoglobulins and enzymes are observed in these same patients, these oligoclonal bands may result in artifactually elevated enzyme results secondary to decreased clearance leading to erroneous clinical decisions. There was no significant relationship between any abnormalities and the presence of neurologic disease as established by a wide variety of other studies. It is important to recognize the limits of CSF interpretation in this patient group.
Hall
C D
CD
Department of Neurology, University of North Carolina, Chapel Hill 27599-7025.
Snyder
C R
CR
Robertson
K R
KR
Messenheimer
J A
JA
Wilkins
J W
JW
Robertson
W T
WT
Whaley
R A
RA
Van der Horst
C
C
Silverman
L M
LM
D000386:AIDS-Related Complex / Q000134:cerebrospinal fluid*; D000163:Acquired Immunodeficiency Syndrome / Q000134:cerebrospinal fluid*; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D005947:Glucose / Q000134:cerebrospinal fluid; D016655:HIV Core Protein p24 / Q000134:cerebrospinal fluid; D015658:HIV Infections / Q000134:cerebrospinal fluid*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D007958:Leukocyte Count; D009504:Neutrophils / Q000473:pathology; D012016:Reference Values; D012709:Serum Albumin / Q000032:analysis
D002556:Cerebrospinal Fluid Proteins; D016655:HIV Core Protein p24; D007074:Immunoglobulin G; D012709:Serum Albumin; D005947:Glucose