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Cerebrospinal fluid in HIV-1 systemic viral controllers: absence of HIV-1 RNA and intrathecal inflammation

Probasco, John Ca,*; Deeks, Steven Gb; Lee, Evelyna; Hoh, Rebeccab; Hunt, Peter Wb; Liegler, Terib; Price, Richard Wa; Spudich, Serena Sa

doi: 10.1097/QAD.0b013e328331e15b
Clinical Science: Concise Communications

Background: A subset of HIV-infected patients, termed ‘elite’ viral controllers, maintain undetectable plasma HIV RNA levels in the absence of therapy. In this group, host-mediated viral control may be accompanied by chronic systemic inflammation. It is unknown whether either infection or chronic inflammation is present within the central nervous system of these individuals.

Methods: Cross-sectional analysis compared cerebrospinal fluid (CSF) HIV RNA and biomarkers of intrathecal inflammation in eight controllers (plasma HIV RNA levels <50 copies/ml) with 26 HIV-uninfected individuals, 25 untreated individuals HIV-infected, viremic individuals, and 23 HIV-infected individuals with treatment-mediated viral suppression (plasma HIV RNA levels <50 copies/ml).

Results: All controllers had CSF HIV RNA levels below 2.5 copies/ml. CSF white blood cell (WBC) counts and CSF: plasma albumin ratios in the controllers were similar to those in both HIV-uninfected individuals and antiretroviral therapy-suppressed HIV-infected individuals. CSF neopterin, MCP-1, and IP-10 concentrations were also not different in the controllers from either HIV-uninfected or treated HIV-infected individuals.

Conclusion: The character of CSF HIV infection and degree of immunoactivation in controllers is comparable to that of HIV-uninfected and antiretroviral therapy-suppressed HIV-infected individuals, but distinct from that of untreated, viremic HIV-infected individuals.

aDepartment of Neurology, USA

bDepartment of Medicine, University of California, San Francisco, San Francisco, California, USA.

*Current address: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Received 26 May, 2009

Revised 1 August, 2009

Accepted 13 August, 2009

Correspondence to Dr Serena S. Spudich, SFGH Rm 4M62, 1001 Potrero Avenue, San Francisco, CA 94110, USA. Tel: +1 415 206 4487; fax: +1 415 476 5582; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.