title: CSF neurofilament protein (NFL) -- a marker of active HIV-related neurodegeneration.
abstract: METHODS
  The light subunit of the neurofilament protein (NFL), a major structural component of myelinated axons, is a sensitive indicator of axonal injury in the central nervous system (CNS) in a variety of neurodegenerative disorders. Cerebrospinal fluid (CSF) NFL concentrations were measured by ELISA (normal < 250 ng/l) in archived samples from 210 HIV-infected patients not taking antiretroviral treatment: 55 with AIDS dementia complex (ADC), 44 with various CNS opportunistic infections/tumours (CNS OIs), 95 without neurological symptoms or signs, and 16 with primary HIV infection (PHI). The effect of highly active antiretroviral treatment (HAART) was studied by repeated CSF sampling in four of the ADC patients initiating treatment.
  
  
  RESULTS
  CSF NFL concentrations were significantly higher in patients with ADC (median 2590 ng/l, IQR 780-7360) and CNS OIs (2315 ng/l, 985-7390 ng/l) than in neuroasymptomatic patients (<250 ng/l, <250-300) or PHI (<250 ng/l, <250-280), p < 0.001. Among patients with ADC, those with more severe disease (stage 2-4) had higher levels than those with milder disease (stage 0.5-1), p < 0.01. CSF NFL declined during HAART to the limit of detection in parallel with virological response and neurological improvement in ADC.CSF NFL concentrations were higher in neuroasymptomatic patients with lower CD4-cell strata than higher, p < 0.001. This increase was less marked than in the ADC patients and noted in 26/58 neuroasymptomatic patients with CD4 counts <200/microl compared to 1/37 with CD4-cells > or =200/microl.
  
  
  CONCLUSIONS
  The findings of this study support the value of CSF NFL as a useful marker of ongoing CNS damage in HIV infection. Markedly elevated CSF NFL concentrations in patients without CNS OIs are associated with ADC, follow the grade of severity, and decrease after initiation of effective antiretroviral treatment. Nearly all previously suggested CSF markers of ADC relate to immune activation or HIV viral load that do not directly indicate brain injury. By contrast NFL is a sensitive marker of such injury, and should prove useful in evaluating the presence and activity of ongoing CNS injury in HIV infection.
authors.affiliation: Department of Infectious Diseases, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden.
authors.forename: Sahra
authors.initials: S
authors.lastname: Abdulle
authors.forename: Asa
authors.initials: A
authors.lastname: Mellgren
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Brew
authors.forename: Paola
authors.initials: P
authors.lastname: Cinque
authors.forename: Lars
authors.initials: L
authors.lastname: Hagberg
authors.forename: Richard W
authors.initials: RW
authors.lastname: Price
authors.forename: Lars
authors.initials: L
authors.lastname: Rosengren
authors.forename: Magnus
authors.initials: M
authors.lastname: Gisslén
mesh_terms: D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid / Q000150:complications / Q000628:therapy; D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000150:complications / Q000628:therapy; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D002452:Cell Count / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D015658:HIV Infections / Q000134:cerebrospinal fluid* / Q000150:complications* / Q000628:therapy; D006801:Humans; D019636:Neurodegenerative Diseases / Q000134:cerebrospinal fluid* / Q000209:etiology* / Q000628:therapy; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid*; D018709:Statistics, Nonparametric
chemical_list: D016900:Neurofilament Proteins