THE EFFECT ON HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 RNA LEVELS IN CEREBROSPINAL-FLUID AFTER INITIATION OF ZIDOVUDINE OR DIDANOSINE

Human immunodeficiency virus type 1 (HIV-1) RNA, neopterin, and beta(2 )-microglobulin levels were analyzed in cerebrospinal fluid (CSF) and serum before and 3-13 months after initiation of antiretroviral monoth erapy in 16 HIV-1-infected persons. Twenty-one treatment periods, 13 a fter initiation of zidovudine and 8 after initiation of didanosine, we re studied. During zidovudine treatment, CSF HIV RNA levels decreased by a mean of 1.05 log(10) (-91%, P < .01), and CSF neopterin and beta( 2)-microglobulin levels by 57% and 33%, respectively (P < .01). No red uction was seen during didanosine treatment in CSF HIV RNA (+0.13 log( 10), not significant), CSF neopterin, or beta(2)-microglobulin levels. Changes in CSF HIV RNA levels correlated with changes in CSF neopteri n and beta(2)-microglobulin (r(s) =.81 and .83, respectively, P < .001 ). The decrease in HIV RNA was significantly larger in CSF than in ser um following zidovudine treatment (P < .01). These data demonstrate th at zidovudine is a potent reducer of central nervous system virus load , which may be important for long-term neuroprotection.