Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet and Swedish Institute for Communicable Disease Control, Stockholm, Sweden.
AIDS. 2013 Apr 24;27(7):1145-9. doi: 10.1097/QAD.0b013e32835cf235.
Elite controllers are a rare subset of HIV-1-infected individuals who maintain HIV-1 RNA concentrations in plasma below the lower limit of quantification of clinical assays (<20-50 copies/ml) in the absence of antiretroviral therapy. Here, we examine to what extent elite controllers also control infection of the central nervous system (CNS).
We analysed paired cerebrospinal fluid (CSF) and plasma samples using a highly sensitive assay for HIV-1 RNA quantification.
We analysed 28 CSF samples and 27 concurrent plasma samples from 14 elite controllers with the highly sensitive single-copy assay (SCA) that allows for HIV-1 RNA quantification down to less than one copy of HIV-1 RNA per millilitre.
Three samples were excluded because of internal standard failure. HIV-1 RNA was detected in only five of 26 CSF samples compared with 14 of 26 plasma samples (P = 0.02), with a median of 0.2 (range, 0.1-6) copies/ml in CSF compared with 0.8 (range, 0.1-189 copies/ml) in plasma (P < 0.0001).
HIV-1 RNA could not be detected in CSF in most elite controllers using the highly sensitive SCA, and when detected, it was at significantly lower frequencies and concentrations than in plasma. Elite controllers thus control HIV-1 in the CNS very well. Whether the infrequent and small amounts of HIV-1 RNA in the CSF reflect production from a local reservoir or virion exchange between the blood and the CSF is uncertain.
精英控制者是 HIV-1 感染者中的一个罕见亚群，他们在未接受抗逆转录病毒治疗的情况下，血浆中 HIV-1 RNA 浓度低于临床检测的下限（<20-50 拷贝/ml）。在这里，我们研究精英控制者在多大程度上也能控制中枢神经系统（CNS）的感染。
我们使用一种高度敏感的 HIV-1 RNA 定量检测方法分析了配对的脑脊液（CSF）和血浆样本。
我们用高度敏感的单拷贝检测法（SCA）分析了 14 名精英控制者的 28 份 CSF 样本和 27 份同期血浆样本，该检测法可检测到每毫升少于 1 拷贝的 HIV-1 RNA。
由于内标失败，有 3 个样本被排除在外。与 26 份血浆样本中的 14 份相比，只有 5 份 CSF 样本中检测到 HIV-1 RNA（P = 0.02），CSF 中的中位数为 0.2（范围，0.1-6）拷贝/ml，而血浆中的中位数为 0.8（范围，0.1-189）拷贝/ml（P < 0.0001）。
使用高度敏感的 SCA，大多数精英控制者的 CSF 中无法检测到 HIV-1 RNA，当检测到 HIV-1 RNA 时，其频率和浓度明显低于血浆。因此，精英控制者很好地控制了中枢神经系统中的 HIV-1。CSF 中 HIV-1 RNA 的数量很少且不频繁是否反映了局部储库的产生或血液与 CSF 之间的病毒粒子交换尚不确定。
