Lуtvуn K.Yu., Shostakovych-Koretska L.R., Hubar I.O.

COMPARATIVE ANALYSIS OF THE LEVEL OF HIV RNA IN CEREBROSPINAL FLUID AND PLASMA IN HIV-ASSOCIATED NEUROLOGICAL DISEASES

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About the author:	Lуtvуn K.Yu., Shostakovych-Koretska L.R., Hubar I.O.
Heading	CLINICAL MEDICINE
Type of article	Scentific article
Annotation	Summary. HIV is present in the central nervous system, starting with primary viremia and, in the absence of treatment, throughout the infection. HIV RNA level in cerebral spinal fluid (CSF) is considered to be an important marker of neurological diseases of the central nervous system in HIV-infected patients. The purpose of the study is to determine the HIV RNA level in the cerebrospinal fluid and plasma in HIV-associated infectious neurological diseases, depending on the immunological status, the etiology and the consequences of the disease. Materials and methods. Data were analyzed for 48 patients aged 21 to 54 years with HIV infection and the presence of infectious diseases of the central nervous system (CNS), including: cerebral tuberculosis - 15 (31.3%), fungal infections (candidiasis, cryptococcosis) - 6 (12.5% ), encephalitis caused by viruses: the Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV) - 11 (22.9%), encephalitis of unspecified etiology - 9 (18.7%), cerebral toxoplasmosis - 7( 14.6%) cases. The majority of patients - 29 (60.4%) were discharged from a hospital with improvement in condition, and 19 (39.6%) patients with severe illness died due to CNS disease. The determination of HIV RNA in CSF was carried out using a polymerase chain reaction based on standardized technology. Statistical processing of the results of the study was conducted using the programs Statistica v.6.1® and MedCalс v.11.5.0 (free download). In order to determine the discriminatory significance of levels of viral load of HIV RNA to predict the course of neurological disease, ROC analysis was performed. Results and discussion. A higher HIV RNA viral load was observed in dead patients - 5.14 (4.39-5.99) Lg copies/ml in CSF and 5.60 (5.25 - 5.99) Lg copies/ml in plasma, which was reliably higher than the one of those who were discharged with improvement status - 4.31 (3.0 - 5.06) Lg copies/ml and 5.10 (3.85-5.83) Lg copies/ml respectively (p <0.05). Correlation between the plasma HIV RNA level and CSF HIV RNA level is determined: the correlation coefficient rs = 0.40; p<0.05. It has been established that the high risk of an unfavorable course of the disease is predicted with an increase in the viral load of HIV RNA in CSF to 5.1 Lg copies/ml or 125,000 copies/ml and higher - the area under the ROC curve AUC = 0.686 ± 0.076 (p = 0.031) provides a sensitivity of the test 52.6%, specificity - 79.3%, accuracy (error-free) of the prognosis - 68.8%. When the same level of HIV RNA in the blood is reached (5.1 Lg copies/ml and higher), the high risk of death is predicted with accuracy of 65.8%, sensitivity of 85.7%, and specificity of 54.2%. At tuberculosis of the central nervous system, the CSF HIV RNA level was higher (median Lg VLs - 5.79 (4.16-6.09) copies/ml) than in other groups. Thus, a statistically significant difference was found with the groups of patients with unspecified viral encephalitis (4.51 (2.66-4.94) copies/ml; p = 0.050 U) and encephalitis caused by EBV, HSV, CMV (4.28 (3,59-4.8) copies/ml; p = 0.048 U). Also, a tendency towards a higher level of HIV RNA viral load in CSF at tuberculosis was revealed, than the one at cerebral toxoplasmosis and fungal lesions of the central nervous system. Conclusions. Assessing of HIV RNA viral load in the cerebrospinal fluid of patients with HIV-associated neurological diseases proved informative for determining the risk of death. The differences in the CSF HIV RNA levels in the various HIV-associated diseases of the central nervous system, with an increase in the number of observations in these groups, may have a diagnostic value.
Tags	HIV infection, HIV-associated neurological diseases, HIV RNA viral load, cerebrospinal fluid (CSF), ROC-analysis
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Publication of the article	«World of Medicine and Biology» №3(65), 2018 year, 086-091 pages, index UDK 616.98:578.828ВІЛ:616.8:577.213/.216:612.824]-07
DOI	10.26724/2079-8334-2018-3-65-86-91