Effects of antiretroviral treatment on blood-brain barrier integrity and intrathecal immunoglobulin production in neuroasymptomatic HIV-1-infected patients.

• OBJECTIVES: To study the effect of antiretroviral combination therapy on blood-brain barrier (BBB) integrity and intrathecal immunoglobulin G (IgG) production. METHODS: Lumbar punctures were performed on 38 neurologically asymptomatic, treatment-naive HIV-1-infected patients prior to and during treatment at intervals of approximately 4 months, 1 year and 2 years. Albumin ratio and IgG index were analysed as markers of BBB integrity and intrathecal IgG synthesis. RESULTS: HIV-1 RNA decreased to < 50 HIV-1 RNA copies/mL in the cerebrospinal fluid (CSF) of all patients and in the plasma of all but one patient. Only 5% of patients had elevated albumin ratio values at baseline, while 56% had an elevated IgG index. There was no significant reduction of the albumin ratio or the IgG index. After 2 years of treatment all patients had normal albumin ratio values, while 41% still had increased IgG index levels. CONCLUSIONS: Up to 2 years after the initiation of treatment, the favourable impact of antiretroviral combination treatment on CSF viral load was not accompanied by a similar reduction of intrathecal IgG production. BBB function, measured as the albumin ratio, was not significantly changed in this cohort of neurologically asymptomatic HIV-1-infected patients.

Nyckelord

Adolescent

Adult

Anti-HIV Agents

pharmacology

therapeutic use

Antiretroviral Therapy

Highly Active

Blood-Brain Barrier

drug effects

Brain

drug effects

immunology

CD4 Lymphocyte Count

Female

Follow-Up Studies

HIV Infections

drug therapy

immunology

metabolism

HIV-1

genetics

Humans

Immunoglobulin G

blood

cerebrospinal fluid

Immunoglobulins

biosynthesis

blood

cerebrospinal fluid

Male

Middle Aged

RNA

Viral

analysis

Serum Albumin

analysis

Statistics

Nonparametric

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ref (ämneskategori)

art (ämneskategori)