Cerebrospinal-fluid HIV-1 RNA and drug concentrations after treatment with lamivudine plus zidovudine or stavudine.
BACKGROUND
Treatment and prevention of HIV-1-related central-nervous-system disease may be dependent on penetration of antiretroviral drugs into the central nervous system. Few data are available about cerebrospinal-fluid penetration and concomitant changes of HIV-1-RNA concentrations during treatment with antiretroviral agents. We investigated these effects in HIV-1-infected people.


METHODS
28 antiretroviral-naive individuals with CD4 cell counts of 200/microL or more and plasma HIV-1-RNA concentrations of 10,000 or more copies/mL who were free of neurological symptoms were randomly assigned lamivudine plus either stavudine (n = 17) or zidovudine (n = 11). We did lumbar punctures on 28 individuals before and 22 individuals after 12 weeks of treatment to assess HIV-1-RNA and drug concentrations in cerebrospinal fluid.


RESULTS
All 28 individuals had detectable HIV-1-RNA concentrations in the cerebrospinal fluid (median 4.64 log10 copies/mL and 4.20 log10 copies/mL in the lamivudine plus zidovudine and lamivudine plus stavudine groups, respectively). There was no correlation between plasma and cerebrospinal-fluid HIV-1-RNA concentrations (r = 0.18, p = 0.35). After 12 weeks of treatment none of the individuals had detectable HIV-1-RNA concentrations in the cerebrospinal fluid. The highest drug concentration in the cerebrospinal fluid was for lamivudine followed by stavudine and zidovudine. Concentrations were consistent over time, unlike plasma concentrations. Therefore, we found time-dependent cerebrospinal-fluid to plasma drug-penetration ratios, which were highest for zidovudine followed by stavudine and lamivudine.


CONCLUSIONS
The two drug combinations were equally effective in the decrease of cerebrospinal fluid HIV-1-RNA concentrations. All drugs penetrated the cerebrospinal fluid. Antiretroviral drugs other than zidovudine might be useful in the prevention of AIDS dementia complex.
D015526:AIDS Dementia Complex / Q000517:prevention & control; D000328:Adult; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000097:blood / Q000134:cerebrospinal fluid* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002851:Chromatography, High Pressure Liquid; D004338:Drug Combinations; D005500:Follow-Up Studies; D016655:HIV Core Protein p24 / Q000134:cerebrospinal fluid; D015658:HIV Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000097:blood / Q000134:cerebrospinal fluid* / Q000627:therapeutic use; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid*; D013129:Spinal Puncture; D018119:Stavudine / Q000008:administration & dosage / Q000097:blood / Q000134:cerebrospinal fluid* / Q000627:therapeutic use; D015215:Zidovudine / Q000008:administration & dosage / Q000097:blood / Q000134:cerebrospinal fluid* / Q000627:therapeutic use