L. Monno et al., Reduced concentrations of HIV-RNA and TNF-alpha coexist in CSF of AIDS patients with progressive multifocal leukoencephalopathy, J NE NE PSY, 67(3), 1999, pp. 369-373
Objectives-To confirm reduced human immunodeficiency virus type-1 (HIV-1) b
urden in the CSF of patients with progressive multifocal leukoencephalopath
y (PML) and to verify whether this viral load coincides with the absence of
inflammatory changes in the CSF.
Methods-Paired CSF and plasma samples from 17 patients with PML, 26 with no
n-PML cerebral opportunistic infections, nine with HIV-1 leukoencephalopath
y (HIVE), and 12 neurologically asymptomatic AIDS patients were subjected t
o HIV-RNA titration. Tumour necrosis factor (TNF)-alpha was also measured a
nd the CSF albumin: serum albumin ratio (Q(Alb)) was calculated.
Results-The CSF HIV-1 burden of patients with PML did not differ from that
of neurologically asymptomatic patients (p=0.21), but was significantly low
er than CSF burden of the remaining patients (non-PML opportunistic infecti
ons, p<0.001; HIVE, p<0.001). Q(Alb) was normal for all neurologically asym
ptomatic patients, for 86.6% patients with PML, and 62.5% patients with HIV
E (p=0.09). Q(Alb) was altered in 91.6% patients with non-PML opportunistic
infections. TNF-alpha in CSF was higher in patients with non-PML opportuni
stic infections (p<0.001) and those with HIVE (p<0.001) than in patients wi
th PML who consistently had TNF-alpha concentrations<10 pg/ml.
Conclusions-These results, while indicating a reduced HIV replication in CS
F of patients with PML which might serve as a disease marker, emphasise the
increased CSF HIV-RNA concentration in patients with HIVE and patients wit
h non-PML opportunistic infections. Low concentrations of HIV-RNA in CSF co
incide with reduced TNF-alpha concentrations, possibly due to particular fe
atures of PML compared with other opportunistic infections as it develops w
ithout detectable inflammatory changes in the CSF.