Intrathecal humoral immunologic response in neurologically symptomatic and asymptomatic patients with human immunodeficiency virus infection.
We analyzed the intrathecal humoral immunologic response in 42 human immunodeficiency virus (HIV)-infected patients. Eighteen patients had clinical neurologic abnormalities, while the remaining 24 patients were neurologically symptom-free. Nine of the neurologically symptomatic patients at early infection had slight neurologic dysfunction; in nine other subjects at late infection, the neurologic impairment was moderate or severe. When compared with symptom-free patients, neurologically symptomatic patients had increased intra-blood-brain barrier (BBB) HIV-specific IgG (p less than 0.001) and total IgG synthesis (p less than 0.01) with oligoclonal bands (OCBs) in the CSF and/or serum (11/18 versus 3/24). At early stages of the infection, neurologically symptomatic patients showed increased total intrathecal IgG synthesis (9/9) coincident with OCBs in the CSF and serum (7/9) and slight mononuclear pleocytosis (7/9), but less frequent HIV-specific IgG production within the CNS (6/9). In advanced infection, the number of neurologically symptomatic patients with intrathecal HIV-specific IgG synthesis (8/9) was higher, while the number of those with increased total intra-BBB IgG synthesis (5/9; p less than 0.01), OCBs (4/9), and increased CSF leukocyte count (1/9; p less than 0.001) was lower than at early infection. Our data suggest humoral intra-BBB immunoactivation at early stages of HIV infection followed by declining B cell response within the CNS at advanced infection.
Elovaara
I
I
Department of Neurology, University of Helsinki, Finland.
Seppälä
I
I
Poutiainen
E
E
Suni
J
J
Valle
S L
SL
D000163:Acquired Immunodeficiency Syndrome / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000032:analysis* / Q000097:blood / Q000134:cerebrospinal fluid; D000917:Antibody Formation; D001812:Blood-Brain Barrier; D001921:Brain / Q000473:pathology; D015483:HIV Antibodies; D006679:HIV Seropositivity / Q000134:cerebrospinal fluid; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis / Q000134:cerebrospinal fluid; D008206:Lymphatic Diseases / Q000276:immunology; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications
D000914:Antibodies, Viral; D015483:HIV Antibodies; D007074:Immunoglobulin G