Variables that influence HIV‐1 cerebrospinal fluid viral load in cryptococcal meningitis: a linear regression analysis

Abstract

BackgroundThe central nervous system is considered a sanctuary site for HIV-1 replication. Variables associated with HIV cerebrospinal fluid (CSF) viral load in the context of opportunistic CNS infections are poorly understood. Our objective was to evaluate the relation between: (1) CSF HIV-1 viral load and CSF cytological and biochemical characteristics (leukocyte count, protein concentration, cryptococcal antigen titer); (2) CSF HIV-1 viral load and HIV-1 plasma viral load; and (3) CSF leukocyte count and the peripheral blood CD4+ T lymphocyte count.MethodsOur approach was to use a prospective collection and analysis of pre-treatment, paired CSF and plasma samples from antiretroviral-naive HIV-positive patients with cryptococcal meningitis and assisted at the Francisco J Muñiz Hospital, Buenos Aires, Argentina (period: 2004 to 2006). We measured HIV CSF and plasma levels by polymerase chain reaction using the Cobas Amplicor HIV-1 Monitor Test version 1.5 (Roche). Data were processed with Statistix 7.0 software (linear regression analysis).ResultsSamples from 34 patients were analyzed. CSF leukocyte count showed statistically significant correlation with CSF HIV-1 viral load (r = 0.4, 95% CI = 0.13-0.63, p = 0.01). No correlation was found with the plasma viral load, CSF protein concentration and cryptococcal antigen titer. A positive correlation was found between peripheral blood CD4+ T lymphocyte count and the CSF leukocyte count (r = 0.44, 95% CI = 0.125-0.674, p = 0.0123).ConclusionOur study suggests that CSF leukocyte count influences CSF HIV-1 viral load in patients with meningitis caused by Cryptococcus neoformans.

HIV-1C env and gag Variation in the Cerebrospinal Fluid and Plasma of Patients with HIV-Associated Cryptococcal Meningitis in Botswana

“…Opportunistic infections of the CNS such as tuberculosis meningitis (TBM) have been shown to play a critical role in HIV compartmentalization [6]; however, there is limited evidence on whether or not cryptococcal meningitis (CM) have similar effects. Previous studies have shown that inflammation of the meninges caused by CM may result in the disruption of the blood-brain barrier (BBB), thereby causing the HIV-infected cells to easily penetrate the barrier into the CNS [7,8]. Once in the CNS, the virus may be subjected to different immune and/or drug pressure; however, whether or not the CNS quasispecies is distinct from those from peripheral blood is still not confirmed.…”

Kinetics of HIV-1 in Cerebrospinal Fluid and Plasma in Cryptococcal Meningitis

“…The CSF cytological and biochemical characteristics were as follows: leukocyte count, 10 cells/mm 3 (4–23); glucose, 39 mg/dL (32.7-50); protein concentration 0.75 g/L (0.48-1.06); and Cryptococcus neoformans capsular polysaccharide antigen titer, 1/100 dilutions (1/10-1/1000). 9 Eighty-five percent of patients had a positive CSF India ink examination. No difference was observed between survivors and non survivors in the CSF cellularity (P=0.31), protein concentration (P=0.81) and Cryptococcus neoformans capsular polysaccharide antigen titer (P=0.27).…”

“…We previously reported on factors that influence CSF HIV-1 concentrations in patients with meningitis by Cryptococcus neoformans . 9 The purpose of the present investigation was to study HIV-1 dynamics during the first 3 weeks of antifungal therapy and to compare concentrations of HIV-1 in the CSF and in the plasma of patients with cryptococcal meningitis. We conducted a longitudinal observational study at a single center.…”

Relationship of Human Immunodeficiency Virus Viral Load in Cerebrospinal Fluid and Plasma in Patients Co-infected With Cryptococcal Meningitis

“…A small study previously demonstrated that HIV-infected patients coinfected with CM have higher CSF viral loads compared with those monoinfected with HIV [ 8 ]. Another found no correlation between CSF cryptococcal antigen and CSF HIV viral load [ 9 ].…”