title: Zidovudine reduces intrathecal immunoactivation in patients with early human immunodeficiency virus type 1 infection.
abstract: OBJECTIVE
  To evaluate the effect of zidovudine on human immunodeficiency virus type 1 (HIV-1)-associated central nervous system infection in Centers for Disease Control and Prevention stage II or III disease.
  
  
  METHODS
  In an open-ended trial, patients received 500 mg of zidovudine twice a day for 12 months. Lumbar punctures, neurological, neuropsychological, and neuroradiological examinations were repeatedly performed during the trial period and were compared with pretrial values. In 11 patients post-trial neurological follow-up of 10 to 20 months was performed.
  
  
  METHODS
  Initially, 14 volunteers with stage II or III disease and intrathecal synthesis of HIV-1-specific antibodies were enrolled. Additionally, patients had slight neuropsychological disturbance or brain atrophy unrelated to other agents than HIV-1. Two patients dropped out because of poor compliance.
  
  
  METHODS
  Intrathecal and systemic immune and virological responses, cognitive performance, and brain images were repeatedly monitored.
  
  
  RESULTS
  After 6 weeks of zidovudine therapy, initial low-grade pleocytosis and elevated levels of beta 2-microglobulin, both in cerebrospinal fluid and in serum samples, declined. Intrathecal HIV-1 antibody synthesis could no longer be detected in half of the patients after 12 months of zidovudine therapy. Patients with defective cognition transiently improved cognitive speed and flexibility after 6 months of therapy. Slight atrophic brain changes, however, remained unchanged.
  
  
  CONCLUSIONS
  Zidovudine reduces intrathecal immuno-activation and transiently improves cognitive functioning in HIV-1-infected subjects who show evidence of central nervous system involvement by HIV-1 but are otherwise asymptomatic.
authors.affiliation: Department of Infectious Diseases, Aurora Hospital, Helsinki, Finland.
authors.forename: I
authors.initials: I
authors.lastname: Elovaara
authors.forename: E
authors.initials: E
authors.lastname: Poutiainen
authors.forename: J
authors.initials: J
authors.lastname: Lähdevirta
authors.forename: L
authors.initials: L
authors.lastname: Hokkanen
authors.forename: R
authors.initials: R
authors.lastname: Raininko
authors.forename: S
authors.initials: S
authors.lastname: Mattinen
authors.forename: A
authors.initials: A
authors.lastname: Virta
authors.forename: J
authors.initials: J
authors.lastname: Suni
authors.forename: A
authors.initials: A
authors.lastname: Ranki
mesh_terms: D000328:Adult; D016516:CD4-CD8 Ratio; D002493:Central Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D003072:Cognition Disorders / Q000209:etiology; D015483:HIV Antibodies / Q000032:analysis / Q000096:biosynthesis; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D015215:Zidovudine / Q000627:therapeutic use*; D001613:beta 2-Microglobulin / Q000032:analysis / Q000134:cerebrospinal fluid
chemical_list: D015483:HIV Antibodies; D007074:Immunoglobulin G; D001613:beta 2-Microglobulin; D015215:Zidovudine