Cerebrospinal fluid HIV-1 RNA levels in asymptomatic patients with early stage chronic HIV-1 infection support for the hypothesis of local virus replication

Felipe García, Graciela Niebla, Joan Romeu, Carmen Vidal, Montserrat Plana, Mar Ortega, Lidia Ruiz, Teresa Gallart, Bonaventura Clotet, José M. Miró, Tomás Pumarola, José M. Gatell

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Objective: To assess HIV-1 RNA levels in cerebrospinal fluid (CSF) and their potential correlation with plasma viral load and central nervous system (CNS) HIV-1 infection markers in stable asymptomatic patients with a CD4 T cell count > 500 x 106 cells/l. Patients and methods: Consecutive patients screened for two trials were eligible for lumbar puncture assessment. At day 0, simultaneous samples of CSF and plasma were obtained and levels of total proteins, albumin, IgC, antibodies against HIV-I p24 antigen, HIV-I RNA (using the polymerase chain technique) and white cells were measured. Results: The integrity of the blood-brain barrier was preserved (albumin index ≥ 7) in 59 out of 70 patients (84%). Intrathecal production of antibodies against HIV-1 p24 antigen was demonstrated in 55 out of 70 individuals (78%). Viral load in CSF was significantly lower than plasma values (3.13 ± 0.95 versus 4.53 ± 0.53, P= 0.0001). HIV-1 RNA was not detected in CSF in only three of the 70 patients (4%). Overall, there was a significant correlation between plasma and CSF HIV-1 RNA levels [r = 0.43, P = 0.0001); however, in 29 patients (41%) there were significant differences (> 1.5 log10 copies/ml) between the viral loads in plasma and CSF. In the multivariate analysis, a high level of protein and white cells in CSF, but not the HIV-1 RNA plasma level, were factors independently associated with a higher level of HIV-1 RNA in CSF (P = 0.0001). Conclusions: HIV-1 RNA can be detected almost always in CSF of asymptomatic patients in early stages of HIV-1 infection including those with a preserved integrity of the blood-brain barrier. The important discrepancies between plasma and CSF viral load, and the independent association between CSF abnormalities and CSF viral load, support the hypothesis of local production of HIV-1.

Original languageEnglish
Pages (from-to)1491-1496
Number of pages6
JournalAIDS
Volume13
Issue number12
DOIs
StatePublished - 1999
Externally publishedYes

Keywords

  • Blood-brain barrier
  • Central nervous system
  • Cerebrospinal fluid
  • HIV-1
  • Viral load

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