CEREBROSPINAL-FLUID P24 ANTIGEN LEVELS AND INTRATHECAL IMMUNOGLOBULIN-G SYNTHESIS ARE ASSOCIATED WITH COGNITIVE DISEASE SEVERITY IN HIV-1

Objective: To lest the hypothesis that selected cerebrospinal fluid (C SF) markers [intrathecal immunoglobulin G (IgG) synthesis rate, oligoc lonal IgG bands, and p24 antigen levels] are associated with the prese nce and severity of clinical HIV-1 neurologic disease. Design and meth ods: CSF and blood parameters from 142 HIV-seropositive subjects from the baseline examination of a longitudinal study were measured and ana lyzed in relationship with clinically derived cognitive impairment gro ups (none, mild, moderate) and with other neurologic and clinical clas sification groups. Subjects with opportunistic infections,. lymphomas or neurosyphilis were excluded. Results: The mean intrathecal IgG synt hesis rate and mean CSF p24 antigen levels both differed significantly among cognitive impairment groups; more impairment was associated wit h a higher rate or level. Mean CSF p24 antigen levels were significant ly higher in HIV-1-seropositive subjects with any HIV-1 neurologic dis ease than in subjects without neurologic disease. In contrast, there w ere no significant differences among seropositive groups in any CSF pa rameter when stratified by systemic disease classification (asymptomat ic HIV-seropositives, AIDS-related complex, or AIDS), independent of n eurologic status. Conclusion: We conclude that there may be a relation ship between the severity of HIV cognitive disease and increasing leve ls of intrathecal IgG synthesis and CSF p24 antigen levels.