Cerebrospinal fluid analyses in HIV patients: a longitudinal study through six years

Abstract

The human immunodeficiency virus (HIV) can cause neurological symptoms. It is not known how the the cerebrospinal fluid (CSF) may change during the infection. Thirty‐eight neurologically asymptomatic HIV patients with CD4 lymphocyte count > 280 × 106/1, were included in the prospective study. CSF was analysed once a year for cell count, oligoclonal IgG, IgG index and CSF:S albumin ratio. Cell free CSF was cultivated for HIV isolation. At inclusion, at year three and six, the CSF anti‐HIV antibody synthesis was measured. HIV‐DNA in CSF cells were analysed at inclusion. More than 80% of the patients had abnormal CSF. At consecutive investigations the IgG index and/or CSF:S albumin ratio were unchanged in most of the patients. These findings resemble those seen in MS, neuroborreliosis or neurolues. HIV was isolated in about half of the patients the first four times but in about one‐third of them later on. At inclusion, HIV‐DNA was found in CSF cells in 95% and intrathecal anti‐HIV antibody synthesis in 65% of the patients. The findings did not correlate with the HIV duration, patients' age or the amount of blood CD4 cells. The results speak in favour of the early penetration of HIV in CSF but for its low neurovirulence.