High Brain and Spinal Viral Loads Presage Neurological Impairment

Health care workers should monitor brain and spinal viral loads in HIV patients, according to research published in Archives of Neurology (2002;59[6]923-928). "If cerebrospinal fluid (CSF) human immunodeficiency virus (HIV) RNA levels are elevated before the development of neuropsychological (NP) impairment, such observation would support prospective monitoring of CSF HIV RNA levels as well as therapeutic interventions designed to lower CSF HIV levels," according to Dr. Ronald J. Ellis and colleagues at the University of California-San Diego, San Diego State University, and the San Diego Veterans Affairs Healthcare System.

The researchers found evidence that high CSF viral loads do indeed presage HIV-induced neurodegeneration. They assessed the prognostic utility of CSF viral loads in 139 HIV patients. Study participants underwent extensive neurologic exams and CSF measurements at least six months apart. Rising CSF HIV levels were a significant predictor of NP degradation, Ellis and coauthors found. Patients carrying 200 copies of viral RNA per mL demonstrated significant deficits in motor and cognitive function. No other factor predicted NP decline as well as CSF HIV levels.

"Because elevated CSF HIV RNA levels (greater than or equal to 200 copies/mL) predict subsequent progression to NP impairment, monitoring of CSF viral load and therapy to reduce CSF HIV RNA levels may be clinically warranted, even if impairment is not identified at the time of lumbar puncture," Ellis and colleagues concluded.

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