Continuing intrathecal immunoactivation despite two years of effective antiretroviral therapy against HIV-1 infection.
OBJECTIVE
To study the effect of antiretroviral combination treatment on intrathecal immunoactivation in HIV-1 infection.


METHODS
Lumbar punctures were performed at baseline, and after 4 months, 1 and 2 years on 30 neurologically asymptomatic, treatment-naive HIV-1-infected patients started on antiretroviral treatment with three or more drugs. Levels of neopterin, beta2-microglobulin and HIV-1 RNA were measured in cerebrospinal fluid (CSF) and blood.


RESULTS
All patients continued the study until the 4-month follow-up, although seven discontinued before the 1-year control, and an additional five discontinued before the control after 2 years. Neopterin, beta2-microglobulin and HIV-1 RNA decreased significantly both in CSF and blood, but although 100% of the patients decreased their CSF concentrations of beta2-microglobulin and HIV-1 RNA to normal levels, only 55% had normal CSF neopterin concentrations after 2 years treatment.


CONCLUSIONS
In addition to CSF viral load, antiretroviral combination therapy substantially decreases the intrathecal immunoactivation as reflected by CSF neopterin and beta2-microglobulin in neuroasymptomatic HIV-1-infected patients. However, almost half of the patients still have slightly increased CSF neopterin concentrations after 2 years of effective treatment, which might reflect an ongoing low-grade viral replication in brain tissue.
Abdulle
Sahra
S
Department of Infectious Diseases, Göteborg University, Sweden.
Hagberg
Lars
L
Svennerholm
Bo
B
Fuchs
Dietmar
D
Gisslén
Magnus
M
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019798:Neopterin / Q000097:blood / Q000134:cerebrospinal fluid; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D019562:Viral Load; D001613:beta 2-Microglobulin / Q000097:blood / Q000134:cerebrospinal fluid
D019380:Anti-HIV Agents; D004338:Drug Combinations; D012367:RNA, Viral; D001613:beta 2-Microglobulin; D019798:Neopterin