CSF, plasma viral load and HIV associated dementia

Area of Science:

• Neuroscience
• Virology
• Immunology

Background:

• Systemic human immunodeficiency virus (HIV) viral load predicts disease progression and treatment response.
• The predictive value of plasma versus cerebrospinal fluid (CSF) viral load for HIV-associated neurological disease remains unclear.

Purpose of the Study:

• To assess the relationship between HIV-1 RNA viral load in plasma and CSF and neurological disease in HIV-infected individuals.
• To evaluate the utility of viral load in predicting the onset of or response to treatment for nervous system disease.

Main Methods:

• Quantitative HIV-1 RNA viral load measurement in plasma and cell-free CSF using RT-PCR (Roche Amplicor Monitor).
• Concurrent comprehensive neurological and neuropsychological evaluations in 47 subjects (10 HIV-negative, 37 HIV-positive).
• Plasma and CSF samples collected within a 3-hour window.

Main Results:

• Systemic viral load in plasma was generally higher than in cell-free CSF.
• Cell-free CSF HIV RNA viral load showed a significant correlation with neurological dysfunction.
• Plasma viral load did not correlate with neurological dysfunction.
• One subject with elevated CSF viral load (>5 Log 10) presented with HIV-associated dementia (HAD).

Conclusions:

• Cell-free CSF HIV RNA viral load is a significant predictor of neurological dysfunction in HIV.
• Plasma viral load is not a reliable predictor of HIV-associated neurological disease.
• CSF viral load may be a valuable biomarker for predicting and managing neurological complications in HIV.