| Publication Abstract Display | | Type: Published Abstract | | Title: Change in CSF RNA level correlates with the effects of antiretroviral therapy on HIV-1 associated neurocognitive disorder. | | Authors: Letendre S, Ellis R, Heaton RK, Atkinson JH, Nelson J, Grant I, McCutchan JA | | Year: 1998 | | Publication: Journal of NeuroVirology | | Volume: 4 Issue: Pages: 357 | | Abstract:Background: Elevated CSF HIV RNA levels are associated with neurocognitive impairment in AIDS. Antiretrovirals appear to both treat and prevent HIV-associated dementia, but the role of CSF HIV RNA as a tool for monitoring antiretroviral effects is unclear. Methods: In an open-label clinical trial of HAART in adults with HIV-associated MCMD or dementia, all had detectable plasma HIV RNA and initiated a new antiretroviral regimen. Subjects were followed with plasma and CSF HIV RNA levels (Amplicor, Roche) from baseline to week 12. Clinically significant neurocognitive improvement was defined as an increase in the global deficit score (GDS) of at least 0.5 units, i.e. a gain of 0.5 standard deviation units relative to age and education adjusted neuropsychological test norms. Results: Of 16 evaluable subjects (median CD4 = 190), median change in RNA was -1.0 in plasma and 1.1 in CSF. Thirty-one percent of subjects achieved a clinically significant improvement in neurocognitive function, 21% deteriorated, and 48% were unchanged. Changes in CSF HIV RNA and GDS were correlated (R=0.53, p=0.05), whereas changes in plasma RNA and GDS were not (R=0.17, p>0.05). Those with more than median decrease in CSF RNA were more likely to improve neurocognitively (Fisher's Exact Test, p-0.03). Conclusions: CSF HIV RNA is a potentially valuable tool for monitoring antiretroviral effects in the CNS which lead to cognitive improvement in HIV-infected patients with neurocognitive disorder. |
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