Memory and Aging Center, Department of Neurology and Division of Geriatric Medicine, Department of Medicine, University of California San Francisco, CA 94143, USA.
J Infect Dis. 2012 Jul 15;206(2):275-82. doi: 10.1093/infdis/jis326. Epub 2012 May 2.
Understanding the earliest central nervous system (CNS) events during human immunodeficiency virus (HIV) infection is crucial to knowledge of neuropathogenesis, but these have not previously been described in humans.
Twenty individuals who had acute HIV infection (Fiebig stages I-IV), with average 15 days after exposure, underwent clinical neurological, cerebrospinal fluid (CSF), magnetic resonance imaging, and magnetic resonance spectroscopy (MRS) characterization.
HIV RNA was detected in the CSF from 15 of 18 subjects as early as 8 days after estimated HIV transmission. Undetectable CSF levels of HIV (in 3 of 18) was noted during Fiebig stages I, II, and III, with plasma HIV RNA levels of 285651, 2321, and 81978 copies/mL, respectively. On average, the CSF HIV RNA level was 2.42 log(10) copies/mL lower than that in plasma. There were no cases in which the CSF HIV RNA level exceeded that in plasma. Headache was common during the acute retroviral syndrome (in 11 of 20 subjects), but no other neurological signs or symptoms were seen. Intrathecal immune activation was identified in some subjects with elevated CSF neopterin, monocyte chemotactic protein/CCL2, and interferon γ-induced protein 10/CXCL-10 levels. Brain inflammation was suggested by MRS.
CSF HIV RNA was detectable in humans as early as 8 days after exposure. CNS inflammation was apparent by CSF analysis and MRS in some individuals during acute HIV infection.
了解人类免疫缺陷病毒（HIV）感染早期的中枢神经系统（CNS）事件对于神经发病机制的认识至关重要，但这些在人类中尚未被描述过。
20 名急性 HIV 感染者（Fiebig 分期 I-IV）在暴露后平均 15 天接受了临床神经学、脑脊液（CSF）、磁共振成像和磁共振波谱（MRS）检查。
18 名受试者中的 15 名在 HIV 估计传播后 8 天内从 CSF 中检测到 HIV RNA。在 Fiebig 分期 I、II 和 III 期，3 名受试者（18 名中的 3 名）的 CSF 中未检测到 HIV，其血浆 HIV RNA 水平分别为 285651、2321 和 81978 拷贝/ml。平均而言，CSF HIV RNA 水平比血浆低 2.42 个对数（10）拷贝/ml。没有 CSF HIV RNA 水平超过血浆水平的情况。急性逆转录病毒综合征期间头痛常见（20 名受试者中的 11 名），但未出现其他神经系统体征或症状。一些 CSF 中新蝶呤、单核细胞趋化蛋白/CCL2 和干扰素γ诱导蛋白 10/CXCL-10 水平升高的受试者存在鞘内免疫激活。MRS 提示脑炎症。
在暴露后 8 天内即可在人类中检测到 CSF HIV RNA。在急性 HIV 感染期间，一些个体的 CSF 分析和 MRS 显示 CNS 炎症明显。
