HAART Appears to Halt HIV-related Brain Damage in HIV Patients

Use of HAART normalizes levels of a protein in HIV positive individuals associated with brain damage, according to results of a Swedish study published in the journal Neurology (October 2007).

Abnormally elevated levels of the light-chain neurofilament protein (NFL) in the cerebral spinal fluid (CFS) provide a marker of central nervous system (CNS) damage in several neurodegenerative disorders, including AIDS dementia complex.

Dr. Asa Mellgren and colleagues of Goteborg University in Sweden evaluated the effects of HAART on the levels of neurofilament light protein in the CSF of 53 HIV patients with and without AIDS dementia complex who underwent repeated lumbar punctures (spinal taps).

Using ELISA tests with a normal reference value < 250 ng/L, the investigators measured NFL in these patients, who had received lumbar punctures before and after initiation of HAART.

Results

·         21 of the subjects had increased CSF NFL levels at baseline, with a median level of 780 ng/L.

·         After 3 months of antiretroviral treatment, NFL concentrations had fallen to normal levels in 48% of these patients (10 of 21), and the median decreased to 340 ng/L (P < 0.001).

·         At 1 year, only 4 of 16 (25%) of the 21 subjects observed for this length of time still had elevated NFL levels.

·         32 subjects had normal NFL at baseline, and all but 1 still had a normal level at follow-up.

·         These effects on CSF NFL were seen in association with clinical improvement in AIDS dementia complex patients, decreases in plasma and CSF HIV RNA, decreases in CSF neopterin, and increases in CD4 cell counts.

Conclusion

Based on these findings, the study authors concluded, “HAART seems to halt the neurodegenerative process(es) caused by HIV-1, as shown by the significant decrease in CSF NFL after treatment initiation.”

In addition, they noted, “CSF NFL may serve as a useful marker in monitoring CNS injury in HIV-1 infection and in evaluating CNS efficacy of antiretroviral therapy.”

Clinic of Infectious Diseases, Södra Älvsborgs Sjukhus, Borås, Sweden; Departments of Infectious Diseases and Neurology, The Sahlgrenska Academy at Göteborg University, Sweden; Department of Neurology, University of California–San Francisco, San Francisco General Hospital, CA; and Departments of Neurology and HIV Medicine, St Vincent's Hospital, University of New South Wales, Sydney, Australia

10/12/07

Reference
Å Mellgren, RW Price, L Hagberg, and others. Antiretroviral treatment reduces increased CSF neurofilament protein (NFL) in HIV-1 infection. Neurology 69(15): 1536-1541. October 2007.