Abstract
BackgroundThe central nervous system is considered a sanctuary site for HIV-1 replication. Variables associated with HIV cerebrospinal fluid (CSF) viral load in the context of opportunistic CNS infections are poorly understood. Our objective was to evaluate the relation between: (1) CSF HIV-1 viral load and CSF cytological and biochemical characteristics (leukocyte count, protein concentration, cryptococcal antigen titer); (2) CSF HIV-1 viral load and HIV-1 plasma viral load; and (3) CSF leukocyte count and the peripheral blood CD4+ T lymphocyte count.MethodsOur approach was to use a prospective collection and analysis of pre-treatment, paired CSF and plasma samples from antiretroviral-naive HIV-positive patients with cryptococcal meningitis and assisted at the Francisco J Muñiz Hospital, Buenos Aires, Argentina (period: 2004 to 2006). We measured HIV CSF and plasma levels by polymerase chain reaction using the Cobas Amplicor HIV-1 Monitor Test version 1.5 (Roche). Data were processed with Statistix 7.0 software (linear regression analysis).ResultsSamples from 34 patients were analyzed. CSF leukocyte count showed statistically significant correlation with CSF HIV-1 viral load (r = 0.4, 95% CI = 0.13-0.63, p = 0.01). No correlation was found with the plasma viral load, CSF protein concentration and cryptococcal antigen titer. A positive correlation was found between peripheral blood CD4+ T lymphocyte count and the CSF leukocyte count (r = 0.44, 95% CI = 0.125-0.674, p = 0.0123).ConclusionOur study suggests that CSF leukocyte count influences CSF HIV-1 viral load in patients with meningitis caused by Cryptococcus neoformans.
Highlights
The central nervous system is considered a sanctuary site for HIV-1 replication
We designed an observational prospective investigation to describe the factors that may influence cerebrospinal fluid (CSF) HIV-1 viral load in patients with meningitis caused by Cryptococcus neoformans
Our study demonstrates that CSF leukocyte count is associated with CSF HIV-1 viral load in patients with meningitis caused by Cryptococcus neoformans
Summary
Variables associated with HIV cerebrospinal fluid (CSF) viral load in the context of opportunistic CNS infections are poorly understood. HIV-1 is found in the CSF of most infected individuals at all stages of the disease, including primary infection and the asymptomatic and symptomatic (i.e., occurrence of CNS opportunistic diseases) phases [2,7,8]. It establishes an active and productive infection, triggering an intrathecal cell-mediated immune response characterized by elevated concentrations of β2-microglobulin and neopterin in the CSF
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