Normalisation of cerebrospinal fluid biomarkers parallels improvement of neurological symptoms following HAART in HIV dementia--case report.
BACKGROUND
Since the introduction of HAART the incidence of HIV dementia has declined and HAART seems to improve neurocognitive function in patients with HIV dementia. Currently, HIV dementia develops mainly in patients without effective treatment, though it has also been described in patients on HAART and milder HIV-associated neuropsychological impairment is still frequent among HIV-1 infected patients regardless of HAART. Elevated cerebrospinal fluid (CSF) levels of markers of neural injury and immune activation have been found in HIV dementia, but neither of those, nor CSF HIV-1 RNA levels have been proven useful as diagnostic or prognostic pseudomarkers in HIV dementia.


METHODS
We report a case of HIV dementia (MSK stage 3) in a 57 year old antiretroviral naïve man who was introduced on zidovudine, lamivudine and ritonavir boosted indinavir, and followed with consecutive lumbar punctures before and after two and 15 months after initiation of HAART. Improvement of neurocognitive function was paralleled by normalisation of CSF neural markers (NFL, Tau and GFAP) levels and a decline in CSF and serum neopterin and CSF and plasma HIV-1 RNA levels.


CONCLUSIONS
The value of these CSF markers as prognostic pseudomarkers of the effect of HAART on neurocognitive impairment in HIV dementia ought to be evaluated in longitudinal studies.
Andersson
Lars-Magnus
LM
Department of Infectious Diseases, Sahlgrenska University Hospital, Göteborg, Sweden. lars-magnus.andersson@infect.gu.se
Hagberg
Lars
L
Rosengren
Lars
L
Fuchs
Dietmar
D
Blennow
Kaj
K
Gisslén
Magnus
M
D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid* / Q000188:drug therapy*; D023241:Antiretroviral Therapy, Highly Active; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged