EnglishУкраїнська
  • Main
  • Useful links
  • Information for Contributors
  • About
  • Editorial board

  • Article
    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


    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
    Bibliography
    • Yunkerov VI, Grigorev SG, Rezvantsev MV. Matematiko-statisticheskaya obrabotka dannyih meditsinskih issledovaniy. 2011;SPb,VMedA:320. [in Russian].
    • Canestri A, Lescure FX, Jaureguiberry S, Moulignier A, Amiel C, Marcelin A, et al. Discordance between cerebral spinal fluid and plasma HIV replication in patients with neurological symptoms who are receiving suppressive antiretroviral therapy. Clinical Infectious Diseases. 2010; 50(5):773-8.
    • Letendre S, Marquie-Beck J, Capparelli E., Best B, Clifford D, Collier AC, et al. Validation of the CNS penetration-effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Archives of neurology. 2008; 65(1):65-70.
    • Letendre S, McClernon D, Ellis RJ, Muñoz-Moreno J, Way L, Clifford D, et al. Persistent HIV in the central nervous system during treatment is associated with worse antiretroviral therapy penetration and cognitive impairment. AIDS. 2009; 74(74):74.
    • Mathur AD, Devesh S. A Comparative Study of CSF Viral RNA Loads between HIV Positive Patients with Neurological Manifestations and Neurologically Asymptomatic HIV Patients. Journal of the Association of Physicians of India. 2017; 65:14.
    • Seipone ID, Singh R, Patel VB, Singh A, Gordon ML, Muema DM, et al. Tuberculous meningitis is associated with higher cerebrospinal HIV-1 viral loads compared to other HIV-1-associated meningitides. PloS one. 2018;13(2),e0192060.
    • Spudich S, Gisslen M, Hagberg L, Lee E, Liegler T, Brew B, et al. Central nervous system immune activation characterizes primary human immunodeficiency virus 1 infection even in participants with minimal cerebrospinal fluid viral burden. Journal of Infectious Diseases. 2011; 204(5):753-60.
    • Tan IL, Smith BR, von Geldern G, Mateen FJ, McArthur JC. HIV-associated opportunistic infections of the CNS. The Lancet Neurology. 2012; 11(7):605-617.
    • Vivithanaporn P, Heo G, Gamble J, Krentz HB, Hoke A, Gill, MJ, et al. Neurologic disease burden in treated HIV/AIDS predicts survival A population-based study. Neurology. 2010; 75(13):1150-8.
    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