title: Central nervous system viral invasion and inflammation during acute HIV infection.
abstract: BACKGROUND
  Understanding the earliest central nervous system (CNS) events during human immunodeficiency virus (HIV) infection is crucial to knowledge of neuropathogenesis, but these have not previously been described in humans.
  
  
  METHODS
  Twenty individuals who had acute HIV infection (Fiebig stages I-IV), with average 15 days after exposure, underwent clinical neurological, cerebrospinal fluid (CSF), magnetic resonance imaging, and magnetic resonance spectroscopy (MRS) characterization.
  
  
  RESULTS
  HIV RNA was detected in the CSF from 15 of 18 subjects as early as 8 days after estimated HIV transmission. Undetectable CSF levels of HIV (in 3 of 18) was noted during Fiebig stages I, II, and III, with plasma HIV RNA levels of 285651, 2321, and 81978 copies/mL, respectively. On average, the CSF HIV RNA level was 2.42 log(10) copies/mL lower than that in plasma. There were no cases in which the CSF HIV RNA level exceeded that in plasma. Headache was common during the acute retroviral syndrome (in 11 of 20 subjects), but no other neurological signs or symptoms were seen. Intrathecal immune activation was identified in some subjects with elevated CSF neopterin, monocyte chemotactic protein/CCL2, and interferon γ-induced protein 10/CXCL-10 levels. Brain inflammation was suggested by MRS.
  
  
  CONCLUSIONS
  CSF HIV RNA was detectable in humans as early as 8 days after exposure. CNS inflammation was apparent by CSF analysis and MRS in some individuals during acute HIV infection.
authors.affiliation: Memory and Aging Center, Department of Neurology and Division of Geriatric Medicine, Department of Medicine, University of California San Francisco, CA 94143, USA. Vvalcour@memory.ucsf.edu
authors.forename: Victor
authors.initials: V
authors.lastname: Valcour
authors.forename: Thep
authors.initials: T
authors.lastname: Chalermchai
authors.forename: Napapon
authors.initials: N
authors.lastname: Sailasuta
authors.forename: Mary
authors.initials: M
authors.lastname: Marovich
authors.forename: Sukalaya
authors.initials: S
authors.lastname: Lerdlum
authors.forename: Duanghathai
authors.initials: D
authors.lastname: Suttichom
authors.forename: Nijasri C
authors.initials: NC
authors.lastname: Suwanwela
authors.forename: Linda
authors.initials: L
authors.lastname: Jagodzinski
authors.forename: Nelson
authors.initials: N
authors.lastname: Michael
authors.forename: Serena
authors.initials: S
authors.lastname: Spudich
authors.forename: Frits
authors.initials: F
authors.lastname: van Griensven
authors.forename: Mark
authors.initials: M
authors.lastname: de Souza
authors.forename: Jerome
authors.initials: J
authors.lastname: Kim
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D000208:Acute Disease; D000328:Adult; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000473:pathology / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid / Q000150:complications* / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000134:cerebrospinal fluid / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000134:cerebrospinal fluid; D055815:Young Adult
chemical_list: D012367:RNA, Viral