MONOKINE PRODUCTS AS PREDICTORS OF AIDS DEMENTIA

Objective: To determine whether or not soluble factors produced by per ipheral blood mononulear cells (PBMC) can predict AIDS dementia. Desig n and methods: PBMC were isolated from individuals with and without AI DS dementia complex (ADC) to determine if the levels of cytokines tumo ur necrosis factor (TNF)-alpha and interleukin (IL)-6, or the producti on of a neurotoxic substance, were significantly different. PBMC were studied after determining that the numbers of monocyte-derived macroph ages isolated by adherence were highly variable from patients with ADC compared with individuals without ADC. We prospectively studied 16 AI DS dementia patients, 13 healthy HIV-seropositive individuals, and eig ht seronegative controls. Supernatants from PBMC were assayed for TNF- alpha, IL-6 and alone for neurotoxicity on human neural cells in vitro . Results: We observed a trend towards worse cognitive and motor perfo rmance in patients suffering from ADC but who had no opportunistic inf ections ('pure dementia'; n = 8). Levels of PBMC IL-6 were significant ly higher in 'pure dementia' patients. There was a trend towards lower levels of PBMC TNF-alpha in the group of patients who had both dement ia and opportunistic infections compared with 'pure dementia' patients . Supernatant from PBMC of ADC patients was significantly more neuroto xic than that from healthy HIV-seropositive individuals. Conclusions: Macrophage isolation from PBMC of patients with ADC was altered. Solub le factors produced from PBMC were significantly more neurotoxic than soluble factors from PBMC of healthy HIV-seropositive individuals. PBM C production of TNF-alpha and IL-6 was not a significant predictor of ADC.