NEUROLOGICAL DISORDERS DURING HIV-1 INFECTION CORRELATE WITH VIRAL LOAD IN CEREBROSPINAL-FLUID BUT NOT WITH VIRUS PHENOTYPE

Objectives: To verify the compartmentalization of HIV-1 within the cen tral nervous system (CNS) and to define whether viral phenotype of HIV -1 isolates from cerebrospinal fluid (CSF) samples and CSF viral load correlate with the presence and type of neurological disorders. Method s: A total of 33 HIV-1-infected patients with and without neurological disorders were included in the study. HIV-1 isolation from paired CSF and peripheral blood mononuclear cell (PBMC) samples was attempted by a standard cocultivation technique; the biological phenotype of HIV-1 isolates was assessed by the MT-2 cell assay. CSF and plasma HIV-RNA levels were measured by a quantitative reverse transcripase-polymerase chain reaction. Results: The rate of HIV-1 isolation from CSF and PBM C was 66% (22 isolates) and 85% (28 isolates), respectively. Seventeen out of 22 (77%) CSF HIV-1 isolates were characterized as non-syncytiu m-inducing, and 15 out of 28 (68%) isolates from PBMC were typed as sy ncytium-inducing (SI). The presence of SI isolates in CSF was limited to patients with HIV-1-, cytomegalovirus- or JC virus-related disorder s and was often associated with high levels of HIV-1 RNA in the CSF. D iscussion: Our results demonstrate a correlation between high levels o f HIV RNA in CSF and the presence of neurological disorders thus indic ating a possible role for HIV-1 RNA in the CSF as a biological marker of neurological disease. The finding of viruses with a different pheno type in paired CSF and PBMC indicates that HIV-1 may evolve differentl y in the brain and in the blood. This suggests compartmentalization of HIV-1 within the CNS. (C) 1998 Lippincott-Raven Publishers.