HIGH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 RNA LOAD IN THE CEREBROSPINAL-FLUID FROM PATIENTS WITH LYMPHOCYTIC MENINGITIS

Thirty-seven matched cerebrospinal fluid (CSF) and plasma samples from 34 human immunodeficiency virus type 1 (HIV-1)-infected patients with suspected meningitis were analyzed for levels of HIV-1 RNA and marker s of inflammation, Patients with tuberculous (n = 9) or cryptococcal ( n = 6) meningitis had the highest CSF virus loads, which in many cases exceeded the levels in plasma, compared with patients with meningococ cal meningitis (n = 3), aseptic meningitis (n = 8), tuberculoma (n = 2 ), or AIDS dementia complex (n = 4) or with normal lumbar punctures (n = 3), CSF virus load correlated significantly with the number of infi ltrating lymphocytes (r = .60, P < .001) but not with plasma virus loa d, the levels of beta(2)-microglobulin in the CSF, or the integrity of the blood-brain barrier. These data suggest significant intrathecal H IV-1 replication in patients with lymphocytic meningeal infections suc h as tuberculous and cryptococcal meningitis.