Cerebrospinal fluid HIV-1 RNA levels: correlation with HIV encephalitis.
OBJECTIVE
Neuropathological abnormalities induced by HIV-1 are not always predictable on the basis of the presence of HIV-related neurological symptoms. HIV-1 RNA load was measured in the cerebrospinal fluid (CSF) of HIV-infected patients to verify whether it could be a marker of HIV-induced neuropathology.


METHODS
Histopathological and immunohistochemical examination of the brain for HIV-1 p24 antigen was performed in 50 HIV-infected patients with neurological symptoms; patients were defined as having HIV encephalitis in the presence of HIV-related lesions or HIV-1 p24 antigen-positive cells. Quantitative polymerase chain reaction for HIV-1 RNA was retrospectively applied to CSF samples that had been drawn 1-60 days prior to death from these 50 patients; paired plasma samples of 28 patients were also analysed.


RESULTS
The CSF HIV-1 RNA copy numbers were significantly higher in 22 patients with HIV encephalitis than in 28 patients without (median, 4.77 log10 versus 3.45 log10 copies/ml; P = 0.0003). No correlation was found between CSF HIV-1 RNA load and the presence of opportunistic brain pathologies at post-mortem examination or between HIV-1 RNA loads in paired CSF and plasma samples.


CONCLUSIONS
High CSF HIV-1 RNA levels are associated with HIV encephalitis, regardless of the presence of opportunistic brain diseases or HIV-1 RNA levels in plasma. Quantitative CSF HIV-1 RNA may therefore be used as a specific marker of HIV-induced neuropathology.
Cinque
P
P
Infectious Diseases Division, San Raffaele Scientific Institute, Milan, Italy.
Vago
L
L
Ceresa
D
D
Mainini
F
F
Terreni
M R
MR
Vagani
A
A
Torri
W
W
Bossolasco
S
S
Lazzarin
A
A
D015526:AIDS Dementia Complex / Q000097:blood / Q000134:cerebrospinal fluid / Q000473:pathology / Q000821:virology*; D017088:AIDS-Related Opportunistic Infections / Q000473:pathology / Q000821:virology; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology / Q000821:virology*; D002555:Cerebrospinal Fluid / Q000821:virology*; D005260:Female; D016655:HIV Core Protein p24 / Q000032:analysis; D015497:HIV-1 / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis / Q000097:blood / Q000134:cerebrospinal fluid*; D019562:Viral Load
D016655:HIV Core Protein p24; D012367:RNA, Viral