Neurocognitive Impairment in HIV-Infected Naïve Patients with Advanced Disease: The Role of Virus and Intrathecal Immune ActivationReport as inadecuate

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Clinical and Developmental ImmunologyVolume 2012 2012, Article ID 467154, 5 pages

Clinical Study

Division of Infectious Diseases, Department of Internal Medicine, “San Gerardo” Hospital, University of Milan-Bicocca, 20900 Monza, Italy

LITA VIALBA, University of Milan, 20157 Milan, Italy

Department of Clinical Medicine and Prevention, University of Milan-Bicocca, SCC Geriatrics, 20900 Monza, Italy

Geriatric Unit, University of Milan, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, 20122 Milan, Italy

Don C. Gnocchi Foundation, IRCCS, 20148 Milan, Italy

Received 14 October 2011; Revised 10 January 2012; Accepted 10 January 2012

Academic Editor: Carlo Torti

Copyright © 2012 Monica Airoldi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To investigate intrathecal immune activation parameters and HIV-RNA in HIV-associated neurocognitive disorders HAND of advanced naïve HIV-infected patients and to evaluate their dynamics before and after initiation of antiretroviral therapy ART. Methods. Cross-sectional and longitudinal analysis of HIV RNA, proinflammatory cytokines IL-6, IL-10, INF-γ, TNF-α, TGF-β1, and TGF-β2 and chemokines MIP-1α, MIP-1β, and MCP-1 in plasma and cerebrospinal fluid CSF of HIV-infected patients with CD4 <200-μL. Results. HAND was diagnosed at baseline in 6-12 patients. Baseline CSF HIV-RNA was comparable in patients with or without HAND, whereas CSF concentration of IL-6 and MIP-1β, proinflammatory cytokines, was increased in HAND patients. CSF evaluation at 12 weeks was available in 10-12 cases. ART greatly reduced HIV-RNA in all patients. Nevertheless, IL-6 and MIP-1β remained elevated after 12 weeks of therapy in HAND patients, in whom CSF HIV RNA decay was slower than the plasmatic one as well. Conclusion. Immune activation, as indicated by inflammatory cytokines, but not higher levels of HIV-RNA is observed in advanced naïve HIV-infected patients with HAND. In HAND patients, ART introduction resulted in a less rapid clearance of CSF viremia compared to plasma and no modifications of intratechal immune activation.

Author: Monica Airoldi, Alessandra Bandera, Daria Trabattoni, Benedetta Tagliabue, Beatrice Arosio, Alessandro Soria, Veronica Raino



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