Clinical value of determination HIV viral load in the cerebrospinal fluid of HIV-infected patients

Aim. To analyze the concentration of HIV RNA in the cerebrospinal fluid and to evaluate its significance in the pathology of the central nervous system among HIV infected persons.

Materials: We examined 36 patients with HIV infection with signs of pathology of the central nervous system. All patients was done completed a standard investigation of cerebrospinal fluid, cytological examination and detection viral load of HIV in the cerebrospinal fluid and serum.

Results. A different of opportunistic and HIV-related disease was diagnosed in 29 patients. The most frequent pathology of the nervous system (12 cases) is a diffuse HIV-associated brain damage occurring in 7 patients in the form of aseptic non purulent meningitis and in 5 patients in the form of encephalitis. The average value of the absolute and relative count of CD4-lymphocytes in patients amounted 147,0 cells/μl (40,0; 408,75) and 10.0% (4,00; 18,50). Pathological changes in cellular composition and protein concentration of cerebrospinal fluid detected in 19 cases. Replication of HIV in the cerebrospinal fluid are detected in 31 of 32 patients not receiving antiretroviral therapy, including 17 patients with normal values of cerebrospinal fluid. The average HIV viral load in the cerebrospinal fluid was 15 133,0 copies/ml (2501,0; 30624,0) or 4,18 (3,35; 4,48) lg HIV RNA, average HIV viral load in serum – 62 784,0 copies/ml (6027,5; 173869,0) or 4,80 4,80 (3,7; 5,2) lg HIV RNA. The concentration of HIV in the cerebrospinal fluid was significantly lower than in serum (4,18 and 4,80 lg HIV RNA, p=0.027). 4 patients with severe, multietiology damage of the central nervous system viral, microbial and fungal etiology, there was an inverse relationship between the concentration of HIV in the cerebrospinal fluid and in serum, the concentrations of HIV was higher in the cerebrospinal fluid.

Conclusion: Among the majority of HIV-infected patients with signs of the central nervous system pathology HIV replication in the cerebrospinal fluid was detected. Observed in some patients HIV replication in the cerebrospinal fluid in the absence of morphological and laboratory changes in the composition of cerebrospinal fluid may reflect indirect effects of HIV the brain, manifested in the form of functional disorders of the central nervous system.

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