Increased blood–brain barrier permeability in neuro-asymptomatic HIV-1-infected individuals—correlation with cerebrospinal uid HIV-1 RNA and neopterin levels

The objective of this study was to assess the frequency of blood–brain barrier (BBB) impairment, as measured by the albumin ratio, in neuro-asymptomatic HIV-1-infected individuals without antiretroviral treatment and the correlation between BBB disruption and intrathecal immune activation and HIV-1 RNA levels. Serum and cerebrospinal uid (CSF) albumin, neopterin, and HIV-1 RNA levels were analysed in 110 neuro-asymptomatic HIV-1-infected individuals at different stages of disease; 63 classiŽed as CDC A, 25 as CDC B, and 22 as CDC C. Increased BBB permeability was found in 17 of 110 (15%) of HIV-1-infected individuals. This proportion was sustained throughout the CDC stages. The albumin ratio was correlated with the CSF neopterin levels (rs = 0.36, P<0:001), the serum neopterin levels (rs = 0.37, P< 0:001), and the CSF HIV-1 RNA levels (rs = 0.26, P< 0:01), but not with the plasma HIV-1 RNA levels. The correlations between the albumin ratio and the CSF and serum neopterin concentrations and the CSF HIV-1 RNA levels indicate that immune activation and, possibly, intrathecal HIV-1 virus replication are important factors associatedwith increasedBBB permeability in HIV-1 infection. Journal of NeuroVirology (2001) 7, 542–547.