Undetectable cerebrospinal fluid HIV RNA and beta-2 microglobulin do not indicate inactive AIDS dementia complex in highly active antiretroviral therapy-treated patients.
OBJECTIVE
To assess whether nonelevated cerebrospinal fluid (CSF) markers could delineate inactive AIDS dementia complex (ADC) in patients receiving highly active antiretroviral therapy (HAART), using neuropsychologic performance change as an indicator of ADC stability.


METHODS
We used data from the abacavir (ABC) ADC trial (n = 78) and examined the patients' neuropsychologic performance change with the Reliable Change Index according to 3 cutoff groups: (1) CSF viral load (VL) <100 copies/mL, (2) CSF beta-2 microglobulin (beta2m) <2.2 mg/L, and (3) CSF VL and CSF beta2m below cutoffs.


RESULTS
CSF marker cutoff groups did not define neuropsychologic change. Linear regression showed that only CSF VL was a weak predictor of neuropsychologic performance change.


CONCLUSIONS
HAART-treated ADC patients with baseline CSF markers of viral and immunologic inactivity did not necessarily have inactive ADC when followed over 12 weeks. More sensitive CSF markers to judge the activity of ADC are urgently needed, whereas the interpretation of these markers should be considered with caution in HAART-treated ADC patients.
Cysique
Lucette A
LA
St. Vincent's Hospital Clinical School, University of New South Wales, Darlinghurst, Sydney, Australia. l.cysique@student.unsw.edu.au
Brew
Bruce J
BJ
Halman
Mark
M
Catalan
Jose
J
Sacktor
Ned
N
Price
Richard W
RW
Brown
Steve
S
Atkinson
J Hampton
JH
Clifford
David B
DB
Simpson
David
D
Torres
Gabriel
G
Hall
Colin
C
Power
Christopher
C
Marder
Karen
K
McArthur
Justin C
JC
Symonds
William
W
Romero
Carmen
C
D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid* / Q000188:drug therapy / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000134:cerebrospinal fluid; D005260:Female; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000134:cerebrospinal fluid*; D019562:Viral Load; D001613:beta 2-Microglobulin / Q000134:cerebrospinal fluid*
D015415:Biomarkers; D012367:RNA, Viral; D001613:beta 2-Microglobulin