title: Single-copy assay quantification of HIV-1 RNA in paired cerebrospinal fluid and plasma samples from elite controllers.
abstract: OBJECTIVE
  Elite controllers are a rare subset of HIV-1-infected individuals who maintain HIV-1 RNA concentrations in plasma below the lower limit of quantification of clinical assays (<20-50 copies/ml) in the absence of antiretroviral therapy. Here, we examine to what extent elite controllers also control infection of the central nervous system (CNS).
  
  
  METHODS
  We analysed paired cerebrospinal fluid (CSF) and plasma samples using a highly sensitive assay for HIV-1 RNA quantification.
  
  
  METHODS
  We analysed 28 CSF samples and 27 concurrent plasma samples from 14 elite controllers with the highly sensitive single-copy assay (SCA) that allows for HIV-1 RNA quantification down to less than one copy of HIV-1 RNA per millilitre.
  
  
  RESULTS
  Three samples were excluded because of internal standard failure. HIV-1 RNA was detected in only five of 26 CSF samples compared with 14 of 26 plasma samples (P = 0.02), with a median of 0.2 (range, 0.1-6) copies/ml in CSF compared with 0.8 (range, 0.1-189 copies/ml) in plasma (P < 0.0001).
  
  
  CONCLUSIONS
  HIV-1 RNA could not be detected in CSF in most elite controllers using the highly sensitive SCA, and when detected, it was at significantly lower frequencies and concentrations than in plasma. Elite controllers thus control HIV-1 in the CNS very well. Whether the infrequent and small amounts of HIV-1 RNA in the CSF reflect production from a local reservoir or virion exchange between the blood and the CSF is uncertain.
authors.affiliation: Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet and Swedish Institute for Communicable Disease Control, Stockholm, Sweden. viktor.dahl@ki.se
authors.forename: Viktor
authors.initials: V
authors.lastname: Dahl
authors.forename: Julia
authors.initials: J
authors.lastname: Peterson
authors.forename: Serena
authors.initials: S
authors.lastname: Spudich
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lee
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Shacklett
authors.forename: Richard W
authors.initials: RW
authors.lastname: Price
authors.forename: Sarah
authors.initials: S
authors.lastname: Palmer
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D020805:Central Nervous System Viral Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology*; D015497:HIV-1 / Q000235:genetics* / Q000276:immunology; D006801:Humans; D007113:Immunity, Innate; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid / Q000276:immunology*; D019562:Viral Load; D014771:Virion / Q000276:immunology
chemical_list: D012367:RNA, Viral