Effects of antiretroviral treatment on blood-brain barrier integrity and intrathecal immunoglobulin production in neuroasymptomatic HIV-1-infected patients.
OBJECTIVE
To study the effect of antiretroviral combination therapy on blood-brain barrier (BBB) integrity and intrathecal immunoglobulin G (IgG) production.


METHODS
Lumbar punctures were performed on 38 neurologically asymptomatic, treatment-naive HIV-1-infected patients prior to and during treatment at intervals of approximately 4 months, 1 year and 2 years. Albumin ratio and IgG index were analysed as markers of BBB integrity and intrathecal IgG synthesis.


RESULTS
HIV-1 RNA decreased to < 50 HIV-1 RNA copies/mL in the cerebrospinal fluid (CSF) of all patients and in the plasma of all but one patient. Only 5% of patients had elevated albumin ratio values at baseline, while 56% had an elevated IgG index. There was no significant reduction of the albumin ratio or the IgG index. After 2 years of treatment all patients had normal albumin ratio values, while 41% still had increased IgG index levels.


CONCLUSIONS
Up to 2 years after the initiation of treatment, the favourable impact of antiretroviral combination treatment on CSF viral load was not accompanied by a similar reduction of intrathecal IgG production. BBB function, measured as the albumin ratio, was not significantly changed in this cohort of neurologically asymptomatic HIV-1-infected patients.
Abdulle
S
S
Department of Infectious Diseases, Göteborg University, Göteborg, Sweden. sahra.abdulle@infect.gu.se
Hagberg
L
L
Gisslén
M
M
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001812:Blood-Brain Barrier / Q000187:drug effects*; D001921:Brain / Q000187:drug effects* / Q000276:immunology; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D007136:Immunoglobulins / Q000096:biosynthesis* / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D012709:Serum Albumin / Q000032:analysis; D018709:Statistics, Nonparametric
D019380:Anti-HIV Agents; D007074:Immunoglobulin G; D007136:Immunoglobulins; D012367:RNA, Viral; D012709:Serum Albumin