Human immunodeficiency virus type 1 is present in the cerebrospinal fluid of a majority of infected individuals (original) (raw)
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Revista do Instituto de Medicina Tropical de São Paulo
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 ...
The Journal of Infectious Diseases, 1998
Thirty-seven matched cerebrospinal fluid (CSF) and plasma samples from 34 human immunodeficiency virus type 1 (HIV-1)-infected patients with suspected meningitis were analyzed for levels of HIV-1 RNA and markers of inflammation. Patients with tuberculous (n Å 9) or cryptococcal (n Å 6) meningitis had the highest CSF virus loads, which in many cases exceeded the levels in plasma, compared with patients with meningococcal meningitis (n Å 3), aseptic meningitis (n Å 8), tuberculoma (n Å 2), or AIDS dementia complex (n Å 4) or with normal lumbar punctures (n Å 3). CSF virus load correlated significantly with the number of infiltrating lymphocytes (r Å .60, P õ .001) but not with plasma virus load, the levels of b 2-microglobulin in the CSF, or the integrity of the blood-brain barrier. These data suggest significant intrathecal HIV-1 replication in patients with lymphocytic meningeal infections such as tuberculous and cryptococcal meningitis. Nervous system pathology is a common manifestation of logic impairment, particularly cognitive dysfunction in AIDS dementia complex (ADC) [8-11], few studies have looked at human immunodeficiency virus type 1 (HIV-1) infection [1, 2]. The virus enters the central nervous system (CNS) early in the effects of meningeal infection on the virus load in the CSF. The aim of this study was, therefore, to assess the effect of the course of HIV-1 infection and has been shown to be present at all stages of disease, irrespective of neurologic symptoms active infection in the CNS on the HIV-1 RNA load in the CSF and to correlate this with markers of inflammation and [3]. The virus infects and replicates in macrophages, microglia, and multinucleate glial cells but is mainly free and present in type of CNS pathology. acellular cerebrospinal fluid (CSF) [4]. Recent methodologic advances have allowed the direct quantification of HIV-1 RNA Methods levels in different body fluids. Such measurements have shown that virus load in blood is a sensitive predictor of HIV-1 disease Patients. Patients were selected from a larger prospective coprogression, with high levels of HIV-1 RNA associated with hort of all patients undergoing a diagnostic lumbar puncture (LP) a poor prognosis [5]. Studies measuring the HIV-1 load in the for suspected meningitis at Gold Fields West Hospital (Westonaria, CSF in patients without evidence of meningitic disease indicate South Africa) between July and November 1996. Patients were that levels are generally lower in this site than in the blood [4, included in this study if they were HIV-1-positive, the LP was 6, 7]. While a number of reports have shown a correlation nontraumatic (õ50 red blood cells/mL of CSF), and a definitive between the virus burden in the CSF and the extent of neurodiagnosis could be made with a high degree of confidence. Matched blood samples were obtained from all patients at the time of LP. HIV diagnosis. Antibodies to HIV-1/2 were detected by use
Arquivos de Neuro-Psiquiatria, 2005
B a c k g ro u n d: Plasma HIV RNA levels reflect systemic viral replication but in CNS it may occur relatively independent of systemic infection, yet clinical application of CSF HIV-1 RNA levels is less clear. O b j e c t i v e: to compare CSF and plasma HIV-1 RNA levels of patients with diff e rent opportunistic neuro l o g ical diseases to those without neurological disease, as well as to correlate these levels with the outcome of the disease and use of HAART. M e t h o d: 97 patients who had lumbar puncture for routine work up of suspected neurological diseases, were divided in 2 groups: without neurological disease (23) and with neurological disease (74). NASBA was used for plasma and CSF HIV RNA. Results: Median CSF viral load was higher in toxoplasmic encephalitis, cryptococcal meningitis, HIV dementia and neurological diseases without a defined etiology when compared to patients without neurological disease. There was no diff e re n c e between plasma viral load in patients with and without neurological diseases. Median viral load was higher in plasma and CSF among patients who died when compared to those successfully treated. CSF and plasma viral load were lower in patients with opportunistic diseases on HAART than without HAART. C o n c l usion: CSF viral load was higher in patients with any neurological disease, but this difference was not present in plasma viral load, suggesting that neurological disease influences more the CSF than plasma compartments. Notwithstanding diff e rent neurological diseases were not possible to be diferentiated by the levels of CSF HIV-1. KEY WORDS: AIDS, HIV, cere b rospinal fluid, HIV-1 RNA, opportunistic infections, viral load, neuro l o g i c a l disease. Níveis de RNA do HIV-1 no líquido cefalorraqueano e plasma e sua correlação com doença neurológica oportunística em um hospital referência em AIDS RESUMO -I n t ro d u ç ã o: Os níveis de RNA do HIV-1 no plasma refletem a replicação viral sistêmica e a re p l i c ação no sistema nervoso central pode ocorrer independentemente da infecção sistêmica, mas a utilidade da medida destes níveis no líquido cefalorraqueano (LCR) permanece indefinida. O b j e t i v o: Comparar os níveis de RNA do HIV-1 no LCR e plasma de pacientes sem doenças neurológicas e com diferentes doenças n e u rológicas, bem como correlacionar estes níveis com a sua evolução e o uso de antire t ro v i r a i s . M é t o d o:
Journal of Neurovirology, 2002
Although the incidence of opportunistic central nervous system (CNS) diseases has markedly declined in developed countries following the advent of highly active antiretroviral therapies (HAARTs), they still represent a major diagnostic and therapeutic challenge over the world. The application of nucleic acid amplification techniques to the study of cerebrospinal fluid (CSF) has contributed substantially to their diagnosis. The detection of specific microbial genomes in the CSF is now the preferred test for some CNS opportunistic diseases, such as progressive multifocal leukoencephalopathy or cytomegalovirus encephalitis. More recent developments of these techniques are the quantitative amplification techniques and postamplification studies. Quantification of nucleic acids in CSF is an important aid both at the time of diagnosis, for the interpretation of positive findings, and during patient follow-up. Postamplification analyses can provide important information with regard to clinical patient management, e.g., detection of genotypic resistance to antimicrobial drugs, and in the attempt to elucidate disease epidemiology and pathogenesis.
Acta Neuropathologica, 1999
In the brain of patients with AIDS, HIV-1 is localised in a productive form in mononuclear cells. One issue that still needs clarification is whether HIV is localised in cells other than those of mononuclear lineage. Gene amplification by polymerase chain reaction/in situ hybridisation (PCR-IS) could shed light on it. In this study, formalin-fixed, paraffin-embedded brain tissue from ten adult AIDS sufferers was used. Five of them showed evidence of HIV encephalitis (HIVE), five did not show any abnormality. Nested PCR revealed HIV-1 DNA in all HIVE cases and in three of the group without HIVE. HIV-1 DNA and RNA were also detected in situ in seven cases (all seven were also HIV-1 DNA positive in tube). A higher signal was located in the white than in the grey matter. HIV-1 DNA was found in microglia, macrophages, perivascular cells, multinucleated gaint cells (MGC) and in CD68-negative cells. Some of them were identified as endothelial cells, astrocytes and oligodendrocytes. Reverse transcriptase-PCR-IS was positive in macrophages, MGC, endothelial and glial cells. These results confirm infection of endothelial cells and other glial cells and give clues about the route of entry of virus into the central nervous system and the pathogenesis of the disease. This study did not give any convincing evidence supporting an infection of neurons by HIV-1.
AIDS, 1998
To optimize the use of polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) for the evaluation of central nervous system (CNS) white-matter lesions that along with clinical findings and magnetic resonance imaging (MRI) can allow a definite diagnosis to be made; also to evaluate treatment with zidovudine plus foscarnet. Design and methods: Fifteen AIDS patients with uncertain CNS white-matter lesions were identified. HIV-1 RNA, cytomegalovirus (CMV) and JC virus (JCV) DNA were measured in a total of 29 CSF samples. The results were correlated with clinical and MRI findings and treatment with zidovudine plus foscarnet was evaluated. Results: Four and five out of 15 patients with CMV DNA ≥ 1 : 625 and JCV DNA ≥ 10 3 copies/µl detected in the CSF were diagnosed with CMV and progressive multifocal leukoencephalopathy (PML), respectively. Six patients who were CMV/JCV-negative with the highest levels of HIV RNA (median, 6.87 log 10 copies/ml) in CSF were considered as having HIV-1 encephalitis. Neurological symptoms were non-supportive for diagnosis as was MRI in 11 out of 15 patients. Nine patients completed a 21-day course of zidovudine plus foscarnet. HIV RNA decreased irrespective of neurological diagnosis. All three HIV-1 encephalitis patients and two out of three patients with CMV leukoencephalopathy improved. In these two latter patients, relief of clinical symptoms coincided with decreased CMV DNA. JCV DNA remained unchanged and all three PML patients deteriorated. Conclusions: Measurement of CSF viral sequences supports the diagnosis of CNS white-matter lesions in AIDS patients. While effective therapy for PML remains elusive, treatment including zidovudine plus foscarnet may be a promising option for HIV-1 and CMV-related manifestations.
Clinical Infectious Diseases, 2021
Background The aim of this large multicenter study was to determine variations in cerebrospinal fluid (CSF) HIV-RNA in different phases of untreated human immunodeficiency virus type 1 (HIV-1) infection and its associations with plasma HIV-RNA and other biomarkers. Methods Treatment naive adults with available CSF HIV-RNA quantification were included and divided into groups representing significant disease phases. Plasma HIV-RNA, CSF white blood cell count (WBC), neopterin, and albumin ratio were included when available. Results In total, 1018 patients were included. CSF HIV-RNA was in median (interquartile range [IQR]) 1.03 log10 (0.37–1.86) copies/mL lower than in plasma, and correlated with plasma HIV-RNA (r = 0.44, P < .01), neopterin concentration in CSF (r = 0.49, P < .01) and in serum (r = 0.29, P < .01), CSF WBC (r = 0.34, P < .01) and albumin ratio (r = 0.25, P < .01). CSF HIV-RNA paralleled plasma HIV-RNA in all groups except neuroasymptomatic patients with ...
Annals of the New York Academy of Sciences, 1994
Virus-associated diseases of the central nervous system (CNS) commonly occur in patients with human immunodeficiency virus (HIV) infection. These include CMV infection (reported in up to 30% of cases), progressive multifocal leukoencephalopathy (PML, 2-7%), herpes simplex virus (HSV, 0-2%) and varicellazoster virus (VZV, 0-2%) infections. Primary CNS lymphoma (4-lo%), furthermore, has been shown to be associated with Epstein-Barr virus (EBV) in 100% of cases. The current diagnostic procedures for these diseases include virus isolation (possible for CMV, HSV, and VZV), and examination of cerebrospinal fluid (CSF) " Address correspondence to Paola Cinque, M.D., Centro Ricerca e Cura patologie HIVcorrelate,