title: Analysis of correlation between cerebrospinal fluid and plasma HIV-1 RNA levels in patients with neurological opportunistic diseases.
abstract: The question of whether HIV-1 RNA in cerebrospinal fluid (CSF) is derived from viral replication in the central nervous system or simply reflects the transit of infected lymphocytes from the blood compartment has long been a matter of debate. Some studies found no correlation between CSF and plasma viral load, whereas others did. The lack of a correlation between the two compartments suggests that the presence of HIV-1 RNA is not simply due to the passive passage of the virus from blood to CSF but rather due to intrathecal replication. To evaluate the correlation between plasma and CSF HIV-1 RNA levels and to identify situations in which there is no correlation between the two compartments, seventy patients were prospectively studied. The association between CSF and plasma viral load was evaluated in the total population and in subgroups of patients with similar characteristics. A correlation between the CSF and plasma compartments was observed for patients undergoing highly active antiretroviral therapy (HAART), those with a CD4 T lymphocyte count lower than 200 cells/mm³, and those with increased CSF protein content. On the other hand, no correlation was observed for patients without adequate virological control, who had a CD4 count higher than 200 cells/mm³ and who did not use HAART. The correlation between the two compartments observed in some patients suggests that CSF HIV-1 RNA levels may reflect plasma levels in these subjects. In contrast, the lack of a correlation between the two compartments in patients who were not on HAART and who had normal CSF proteins and a poor virological control possibly indicates compartmentalization of the virus in CSF and, consequently, plasma-independent intrathecal viral replication.
authors.affiliation: Department of Neurology, Santa Casa de Belo Horizonte, Eduardo de Menezes Hospital, FHEMIG, Belo Horizonte, MG, Brazil. ppc@gold.com.br
authors.forename: Paulo Pereira
authors.initials: PP
authors.lastname: Christo
authors.forename: Dirceu Bartolomeu
authors.initials: DB
authors.lastname: Greco
authors.forename: Agdemir Waleria
authors.initials: AW
authors.lastname: Aleixo
authors.forename: Jose António
authors.initials: JA
authors.lastname: Livramento
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000821:virology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D020805:Central Nervous System Viral Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000821:virology*; D005260:Female; D015497:HIV-1 / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood* / Q000134:cerebrospinal fluid*; D019562:Viral Load; D014779:Virus Replication; D055815:Young Adult
chemical_list: D012367:RNA, Viral