期刊
JOURNAL OF INFECTIOUS DISEASES
卷 206, 期 2, 页码 275-282出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jis326
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资金
- National Institute of Mental Health [NIH-R21 MH086341]
- Military HIV Research Program, Walter Reed Army Institute of Research (Rockville, MD)
- Henry M. Jackson Foundation for the Advancement of Military Medicine [W81XWH-07-2-0067]
- US Department of Defense [W81XWH-07-2-0067]
- Intramural research program of the NIAID
- Intramural research program of the Vaccine and Gene Therapy Institute
- Gilead (Truvada, Atripla)
- Merck (Sustiva, Isentress)
- Pfizer (Selzentry)
Background. Understanding the earliest central nervous system (CNS) events during human immunodeficiency virus (HIV) infection is crucial to knowledge of neuropathogenesis, but these have not previously been described in humans. Methods. Twenty individuals who had acute HIV infection (Fiebig stages I-IV), with average 15 days after exposure, underwent clinical neurological, cerebrospinal fluid (CSF), magnetic resonance imaging, and magnetic resonance spectroscopy (MRS) characterization. Results. HIV RNA was detected in the CSF from 15 of 18 subjects as early as 8 days after estimated HIV transmission. Undetectable CSF levels of HIV (in 3 of 18) was noted during Fiebig stages I, II, and III, with plasma HIV RNA levels of 285 651, 2321, and 81 978 copies/mL, respectively. On average, the CSF HIV RNA level was 2.42 log(10) copies/mL lower than that in plasma. There were no cases in which the CSF HIV RNA level exceeded that in plasma. Headache was common during the acute retroviral syndrome (in 11 of 20 subjects), but no other neurological signs or symptoms were seen. Intrathecal immune activation was identified in some subjects with elevated CSF neopterin, monocyte chemotactic protein/CCL2, and interferon gamma-induced protein 10/CXCL-10 levels. Brain inflammation was suggested by MRS. Conclusions. CSF HIV RNA was detectable in humans as early as 8 days after exposure. CNS inflammation was apparent by CSF analysis and MRS in some individuals during acute HIV infection.
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