EFFECT OF ANTIRETROVIRAL THERAPY ON THE CEREBROSPINAL-FLUID OF PATIENTS SEROPOSITIVE FOR THE HUMAN-IMMUNODEFICIENCY-VIRUS

Elevated levels of beta2-microglobulin and neopterin in cerebrospinal fluid (CSF) have been associated with neurologic complications of infe ction with the human immunodeficiency virus (HIV). The effect of zidov udine (ZDV) on these markers was assessed by studying the effect of ZD V treatment duration on CSF levels in a cohort of 145 HIV-positive men who were receiving ZDV. CSF beta2-microglobulin and neopterin levels were significantly lower in those who had been taking ZDV for an inter mediate period of time (46-365 days) than in those who had received ZD V either long term (>365 days) or short term (1-45 days). CSF quinolin ic acid levels were independent of duration of ZDV administration. A s econd CSF evaluation was available after 1 year for 54 HIV-positive me n (19 of whom were also in the first cohort) and 11 HIV-negative contr ols. Patients who had started ZDV between lumbar punctures showed a si gnificant decrease in CSF beta2-microglobulin, but in those who had be en receiving ZDV for >1 year beta2-microglobulin increased (p = 0.001) . The effect was not observed with neopterin (p = 0. 14). (Quinolinic acid levels were not studied longitudinally.) Finally, we observed tha t CSF levels of beta2-microblobulin, neopterin, and quinolinic acid co rrelated strongly with each other in HIV-positive individuals (r = 0.7 , p < 0.0001), even though ZDV might have different effects on these m arkers. In conclusion, we report that initiation of ZDV therapy is ass ociated with a transient decrease in CSF levels of beta2-microglobulin and neopterin. This pattern is consistent with the reported short-ter m benefit of ZDV treatment on HIV infection in the nervous system.