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Relationship of cerebrospinal fluid immune activation associated factors to HIV encephalitis
C A Wiley1, C L Achim, R D Schrier
1Department of Pathology, University of California San Diego, La Jolla 92093-0612.
Objectives And Design:
Because macrophages are the predominant immune cell and the predominant infected cell in the brains of patients with HIV encephalitis, we studied macrophage and immune activation-associated factors in the cerebrospinal fluid (CSF) from 39 autopsied AIDS cases for whom complete neuropathologic evaluation of the brain was available.
Results:
CSF HIV p24 antigen was present in less than one-third of cases (11 out of 39). Less than half of the autopsies with moderate to severe parenchymal infection by HIV had high levels of CSF p24, although all autopsies with elevated levels of HIV p24 had moderate to severe HIV encephalitis. Elevated levels of cytokines, beta 2-microglobulin, neopterin, and quinolinic acid were observed.
Conclusions:
Although many of the CSF findings showed a strong correlation with each other, none showed a strong correlation with the severity of HIV infection of the brain itself. The absence of a close association between CSF abnormalities and HIV encephalitis could reflect the abundance of complicating opportunistic infections in these terminally ill patients or the inadequacy of CSF as a marker of basal ganglia involvement in HIV encephalitis. These findings complicate interpretation of clinical studies of CSF in patients with AIDS where neuropathologic evaluation is unavailable.
Insights
Cerebrospinal fluid (CSF) immune markers showed elevated levels in AIDS patients but did not strongly correlate with HIV encephalitis severity. These findings complicate using CSF to assess brain involvement in HIV/AIDS.
Area of Science:
- Neuroimmunology
- Infectious Diseases
- Pathology
Background:
- Macrophages are key immune and infected cells in HIV encephalitis.
- Cerebrospinal fluid (CSF) analysis is crucial for understanding central nervous system involvement in HIV/AIDS.
Purpose of the Study:
- To investigate macrophage and immune activation markers in CSF.
- To correlate CSF findings with neuropathologic evaluation in autopsied AIDS cases.
Main Methods:
- Analysis of CSF from 39 autopsied AIDS cases.
- Assessment of HIV p24 antigen, cytokines, beta 2-microglobulin, neopterin, and quinolinic acid.
- Correlation with neuropathologic findings of HIV encephalitis.
Main Results:
- CSF HIV p24 antigen was detected in less than one-third of cases.
- Elevated CSF p24 correlated with moderate to severe HIV encephalitis.
- Elevated levels of cytokines, beta 2-microglobulin, neopterin, and quinolinic acid were observed.
Conclusions:
- CSF abnormalities did not strongly correlate with HIV encephalitis severity.
- CSF may be inadequate for assessing basal ganglia involvement in HIV encephalitis.
- Findings complicate clinical interpretation of CSF studies in AIDS patients without neuropathologic data.