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J Neuroinflammation. 2013 May 10;10:62. doi: 10.1186/1742-2094-10-62.

Cerebrospinal fluid neopterin decay characteristics after initiation of antiretroviral therapy.

Author information

1
Department of Infectious Diseases, University of Gothenburg, Journalvagen 10, Gothenburg, 416 50, Sweden. aylin.yilmaz@gu.se

Abstract

BACKGROUND:

Neopterin, a biomarker of macrophage activation, is elevated in the cerebrospinal fluid (CSF) of most HIV-infected individuals and decreases after initiation of antiretroviral therapy (ART). We studied decay characteristics of neopterin in CSF and blood after commencement of ART in HIV-infected subjects and estimated the set-point levels of CSF neopterin after ART-mediated viral suppression.

METHODS:

CSF and blood neopterin were longitudinally measured in 102 neurologically asymptomatic HIV-infected subjects who were treatment-naïve or had been off ART for ≥ 6 months. We used a non-linear model to estimate neopterin decay in response to ART and a stable neopterin set-point attained after prolonged ART. Seven subjects with HIV-associated dementia (HAD) who initiated ART were studied for comparison.

RESULTS:

Non-HAD patients were followed for a median 84.7 months. Though CSF neopterin concentrations decreased rapidly after ART initiation, it was estimated that set-point levels would be below normal CSF neopterin levels (<5.8 nmol/L) in only 60/102 (59%) of these patients. Pre-ART CSF neopterin was the primary predictor of set-point (P <0.001). HAD subjects had higher baseline median CSF neopterin levels than non-HAD subjects (P <0.0001). Based on the non-HAD model, only 14% of HAD patients were predicted to reach normal levels.

CONCLUSIONS:

After virologically suppressive ART, abnormal CSF neopterin levels persisted in 41% of non-HAD and the majority of HAD patients. ART is not fully effective in ameliorating macrophage activation in CNS as well as blood, especially in subjects with higher pre-ART levels of immune activation.

PMID:
23664008
PMCID:
PMC3657550
DOI:
10.1186/1742-2094-10-62
[Indexed for MEDLINE]
Free PMC Article

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