EVALUATION OF HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) TYPE-1 RNA LEVELS INCEREBROSPINAL-FLUID AND VIRAL RESISTANCE TO ZIDOVUDINE IN CHILDREN WITH HIV ENCEPHALOPATHY

The amount of human immunodeficiency virus (HIV) type 1 RNA and the pr esence of a codon 215 mutation indicative of zidovudine resistance wer e evaluated in cerebrospinal fluid (CSF) and plasma obtained from HIV- 1-infected children, The level of HIV-1 RNA in CSF was highest in chil dren with severe encephalopathy (n = 25; median, 430 copies/mL; range, 0-2.2 x 10(5) copies/mL) followed by the moderately encephalopathic ( n = 7; median, 330; range, 0-1130) and nonencephalopathic groups (n = 9; median, 0; range, 0-566) (P = .007), There was no correlation betwe en CSF and plasma HIV-1 RNA levels. Five of 7 children with the codon 215 mutation in CSF had a progression of encephalopathy, while all 8 c hildren with wild type codon 215 had improved or stable disease during zidovudine treatment (P = .007), These findings suggest that increase d viral replication and emergence of drug-resistant HIV-1 variants wit hin the central nervous system may play a role in progression of HIV e ncephalopathy.