Original Article

Cerebrospinal fluid human immunodeficiency virus type 1 RNA levels are elevated in neurocognitively impaired individuals with acquired immunodeficiency syndrome

  1. Dr. Ronald J. Ellis MD, PhD1,*,
  2. Karen Hsia PhD2,
  3. Stephen A. Spector MD2,
  4. Julie A. Nelson BS3,
  5. Robert K. Heaton PhD3,
  6. Mark R. Wallace MD7,
  7. Ian Abramson PhD5,
  8. J. Hampton Atkinson MD3,6,
  9. Igor Grant MD3,6,
  10. J. Allen McCutchan MD4

Article first published online: 8 OCT 2004

DOI: 10.1002/ana.410420503

Issue

Annals of Neurology

Annals of Neurology

Volume 42, Issue 5, pages 679–688, November 1997

Additional Information

How to Cite

Ellis, R. J., Hsia, K., Spector, S. A., Nelson, J. A., Heaton, R. K., Wallace, M. R., Abramson, I., Atkinson, J. H., Grant, I. and McCutchan, J. A. (1997), Cerebrospinal fluid human immunodeficiency virus type 1 RNA levels are elevated in neurocognitively impaired individuals with acquired immunodeficiency syndrome. Annals of Neurology, 42: 679–688. doi: 10.1002/ana.410420503

Author Information

  1. 1

    Department of Neurosciences, University of California, San Diego

  2. 2

    Department of Pediatrics, University of California, San Diego

  3. 3

    Department of Psychiatry, University of California, San Diego

  4. 4

    Department of Medicine, University of California, San Diego

  5. 5

    Department of Mathematics, University of California, San Diego

  6. 6

    Department of Medicine, Naval Hospital of San Diego

  7. 7

    San Diego VA Medical Center, San Diego, CA

*University of California, San Diego, HIV Neurobehavioral Research Center, 2760 Fifth Avenue, San Diego, CA 92103

Publication History

  1. Issue published online: 8 OCT 2004
  2. Article first published online: 8 OCT 2004
  3. Manuscript Accepted: 1 JUL 1997
  4. Manuscript Revised: 13 MAY 1997
  5. Manuscript Received: 12 MAR 1997

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Abstract

To determine whether cerebrospinal fluid (CSF) viral burden measurements can assist in the evaluation of human immunodeficiency virus (HIV)-associated neurocognitive disorders, we quantified HIV type 1 (HIV-1) RNA in CSF. Because previous findings suggested that disease stage, lymphocytic pleocytosis, and HIV-1 RNA levels in plasma may influence CSF viral burden, these variables were examined as potential modifying factors. HIV-1 RNA levels were quantified by using a reverse transcriptase–polymerase chain reaction assay. Performance on a comprehensive neuropsychological (NP) battery was noted in 97 prospectively enrolled, HIV-infected subjects. Among subjects with acquired immunodeficiency syndrome (AIDS) (<200 CD4 lymphocytes), NP impairment was associated with significantly higher CSF RNA levels (3.1 vs 1.8 log10 copies/ml; p = 0.02); most impaired subjects met criteria for HIV-associated dementia or minor cognitive–motor disorder. In subjects without AIDS, CSF RNA and NP impairment were unrelated. Before AIDS, CSF RNA was strongly correlated to plasma RNA and to pleocytosis, but in AIDS, CSF and plasma RNA were independent. In conclusion, we found elevated CSF HIV-1 RNA levels in NP impaired subjects with AIDS. Before AIDS, systemic viral replication, possibly through CD4+ mononuclear cell trafficking, may govern virus levels in CSF, whereas in AIDS, CD4 cell depletion may unmask a correlation between increased productive central nervous system HIV infection and clinical neurocognitive disorders.

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