Monno L, Di Stefano M, Zimatore G B, Andreula C F, Appice A, Perulli L M, Fiore J R, Pastore G, Angarano G
Clinic of Infectious Diseases, University of Bari, Italy.
AIDS. 1998 Apr 16;12(6):581-90. doi: 10.1097/00002030-199806000-00006.
To optimize the use of polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) for the evaluation of central nervous system (CNS) white-matter lesions that along with clinical findings and magnetic resonance imaging (MRI) can allow a definite diagnosis to be made; also to evaluate treatment with zidovudine plus foscarnet.
Fifteen AIDS patients with uncertain CNS white-matter lesions were identified. HIV-1 RNA, cytomegalovirus (CMV) and JC virus (JCV) DNA were measured in a total of 29 CSF samples. The results were correlated with clinical and MRI findings and treatment with zidovudine plus foscarnet was evaluated.
Four and five out of 15 patients with CMV DNA > or = 1 : 625 and JCV DNA > or = 10(3) copies/microl detected in the CSF were diagnosed with CMV and progressive multifocal leukoencephalopathy (PML), respectively. Six patients who were CMV/JCV-negative with the highest levels of HIV RNA (median, 6.87 log10 copies/ml) in CSF were considered as having HIV-1 encephalitis. Neurological symptoms were non-supportive for diagnosis as was MRI in 11 out of 15 patients. Nine patients completed a 21-day course of zidovudine plus foscarnet. HIV RNA decreased irrespective of neurological diagnosis. All three HIV-1 encephalitis patients and two out of three patients with CMV leukoencephalopathy improved. In these two latter patients, relief of clinical symptoms coincided with decreased CMV DNA. JCV DNA remained unchanged and all three PML patients deteriorated.
Measurement of CSF viral sequences supports the diagnosis of CNS white-matter lesions in AIDS patients. While effective therapy for PML remains elusive, treatment including zidovudine plus foscarnet may be a promising option for HIV-1 and CMV-related manifestations.
优化聚合酶链反应（PCR）在脑脊液（CSF）检测中的应用，以评估中枢神经系统（CNS）白质病变，结合临床症状和磁共振成像（MRI）结果做出明确诊断；同时评估齐多夫定联合膦甲酸钠的治疗效果。
确定15例中枢神经系统白质病变情况不明的艾滋病患者。对总共29份脑脊液样本检测HIV-1 RNA、巨细胞病毒（CMV）和JC病毒（JCV）DNA。将检测结果与临床症状和MRI结果进行关联分析，并评估齐多夫定联合膦甲酸钠的治疗效果。
脑脊液中检测到CMV DNA≥1:625的15例患者中有4例被诊断为CMV感染，检测到JCV DNA≥10³拷贝/微升的患者中有5例被诊断为进行性多灶性白质脑病（PML）。6例脑脊液中HIV RNA水平最高（中位数为6.87 log₁₀拷贝/毫升）且CMV/JCV检测为阴性的患者被认为患有HIV-1脑炎。15例患者中有11例的神经症状和MRI结果均不支持诊断。9例患者完成了为期21天的齐多夫定联合膦甲酸钠治疗。无论神经学诊断结果如何，HIV RNA均有所下降。所有3例HIV-1脑炎患者以及3例CMV白质脑病患者中的2例病情有所改善。在这2例病情改善的患者中，临床症状缓解与CMV DNA下降同时出现。JCV DNA保持不变，所有3例PML患者病情恶化。
脑脊液病毒序列检测有助于艾滋病患者中枢神经系统白质病变的诊断。虽然PML的有效治疗方法仍未找到，但包括齐多夫定联合膦甲酸钠在内的治疗方法可能是治疗HIV-1和CMV相关表现的一个有前景的选择。
