title: Absence of Cerebrospinal Fluid Signs of Neuronal Injury Before and After Immediate Antiretroviral Therapy in Acute HIV Infection.
abstract: BACKGROUND
  It is unknown whether neuronal injury begins during acute human immunodeficiency virus (HIV) infection, and whether immediate initiation of combination antiretroviral therapy (cART) prevents neuronal injury.
  
  
  METHODS
  Cerebrospinal fluid (CSF) neurofilament light chain (NFL), a measure of axonal injury, was assessed before and after cART initiation in individuals starting treatment during acute or chronic HIV infection. Nonparametric statistics examined relationships between NFL and disease progression, neuroinflammation, and cognitive performance.
  
  
  RESULTS
  Before treatment, subjects with acute infection had lower CSF NFL levels, with elevations for their age in 1 of 32 subjects with acute infection (3.1%) and 10 of 32 with chronic infection (31%) (P = .006). This persisted after cART initiation, with 1 of 25 acute (4%) and 4 of 9 chronic subjects (44%) showing elevated NFL levels (P = .01). In acute infection, pre-cART NFL levels were inversely correlated with proton magnetic resonance spectroscopic findings of N-acetylaspartate/creatine in frontal gray matter (r = -0.40; P = .03), frontal white matter (r = -0.46; P = .01), and parietal gray matter (r = -0.47; P = .01); correlations persisted after treatment in the frontal white matter (r = -0.51; P = .02) and parietal gray matter (r = -0.46; P = .04).
  
  
  CONCLUSIONS
  CSF NFL levels are not elevated in untreated acute HIV infection or after 6 months of immediately initiated cART but are abnormal in chronic HIV infection before and after treatment. In acute HIV infection, CSF NFL levels are inversely associated with neuroimaging markers of neuronal health.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Peluso
authors.affiliation: Memory and Aging Center, Department of Neurology, University of California, San Francisco.
authors.forename: Victor
authors.initials: V
authors.lastname: Valcour
authors.affiliation: US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland SEARCH, The Thai Red Cross AIDS Research Center.
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.affiliation: Division of Neurology, Department of Internal Medicine, Phramongkutklao Hospital.
authors.forename: Pasiri
authors.initials: P
authors.lastname: Sithinamsuwan
authors.affiliation: SEARCH, The Thai Red Cross AIDS Research Center.
authors.forename: Thep
authors.initials: T
authors.lastname: Chalermchai
authors.affiliation: SEARCH, The Thai Red Cross AIDS Research Center.
authors.forename: James L K
authors.initials: JL
authors.lastname: Fletcher
authors.affiliation: Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Sukalya
authors.initials: S
authors.lastname: Lerdlum
authors.affiliation: SEARCH, The Thai Red Cross AIDS Research Center.
authors.forename: Nitiya
authors.initials: N
authors.lastname: Chomchey
authors.affiliation: US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Slike
authors.affiliation: Huntington Medical Research Institutes, Pasadena, California.
authors.forename: Napapon
authors.initials: N
authors.lastname: Sailasuta
authors.affiliation: Institute of Biomedicine, Department of Infectious Diseases, The Sahlgrenska Academy at the University of Gothenburg.
authors.forename: Magnus
authors.initials: M
authors.lastname: Gisslén
authors.affiliation: Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden UCL Institute of Neurology, Queen Square, London, United Kingdom.
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Serena
authors.initials: S
authors.lastname: Spudich
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000134:cerebrospinal fluid* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid*; D059906:Neuroimaging; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D016900:Neurofilament Proteins
keywords: HIV/AIDS; antiretroviral therapy; magnetic resonance spectroscopy; neurofilament light chain; neuroinflammation; neurological injury