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. 1994 Jul;57(7):784–789. doi: 10.1136/jnnp.57.7.784

Cerebrospinal fluid HIV-1 p24 antigen and culture: sensitivity and specificity for AIDS-dementia complex.

B J Brew 1, M O Paul 1, G Nakajima 1, A Khan 1, H Gallardo 1, R W Price 1
PMCID: PMC1073015  PMID: 8021661

Abstract

We prospectively evaluated 94 patients with AIDS-dementia complex (ADC) and a smaller group of 27 patients with other HIV-1 related neurological conditions to determine the usefulness of cerebrospinal fluid (CSF) p24 antigen and HIV-1 culture in the diagnosis of ADC. The presence of ADC correlated with detectable CSF p24, but not with a positive culture. However, only 54% of the patients with severe or end stage (stages 3 and 4) ADC had detectable CSF p24 and only 25% had a positive culture. Among those with detectable CSF p24, there was no discernible relationship between the severity of ADC and the amount of CSF p24. The diagnostic sensitivity of CSF p24 in ADC was 21% whereas the specificity was 98%. CSF HIV-1 culture had a sensitivity of 30% and a specificity of 80%. To address the possibility of binding of p24 in immune complexes, thereby escaping detection, an acid hydrolysis procedure was performed on the CSF and serum samples. This did not, however, make an appreciable difference in the detection rate of p24. To delineate whether the finding of cell free virus in the CSF was associated with ADC, CSF culture for HIV-1 was performed on both cell depleted and cell associated fractions. It was uncommon for CSF to be culture positive in only the cell free fraction and there was no relationship to the presence or severity of ADC.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brew B. J., Bhalla R. B., Fleisher M., Paul M., Khan A., Schwartz M. K., Price R. W. Cerebrospinal fluid beta 2 microglobulin in patients infected with human immunodeficiency virus. Neurology. 1989 Jun;39(6):830–834. doi: 10.1212/wnl.39.6.830. [DOI] [PubMed] [Google Scholar]
  2. Brew B. J., Bhalla R. B., Paul M., Gallardo H., McArthur J. C., Schwartz M. K., Price R. W. Cerebrospinal fluid neopterin in human immunodeficiency virus type 1 infection. Ann Neurol. 1990 Oct;28(4):556–560. doi: 10.1002/ana.410280413. [DOI] [PubMed] [Google Scholar]
  3. Chiodi F., Asjö B., Fenyö E. M., Norkrans G., Hagberg L., Albert J. Isolation of human immunodeficiency virus from cerebrospinal fluid of antibody-positive virus carrier without neurological symptoms. Lancet. 1986 Nov 29;2(8518):1276–1277. doi: 10.1016/s0140-6736(86)92699-1. [DOI] [PubMed] [Google Scholar]
  4. Chiodi F., Sönnerborg A., Albert J., Gaines H., Norkrans G., Hagberg L., Asjö B., Strannegård O., Fenyö E. M. Human immunodeficiency virus infection of the brain. I. Virus isolation and detection of HIV specific antibodies in the cerebrospinal fluid of patients with varying clinical conditions. J Neurol Sci. 1988 Jul;85(3):245–257. doi: 10.1016/0022-510x(88)90184-0. [DOI] [PubMed] [Google Scholar]
  5. Eeg-Olofsson O., Link H., Wigertz A. Concentrations of CSF proteins as a measure of blood brain barrier function and synthesis of IgG within the CNS in 'normal' subjects from the age of 6 months to 30 years. Acta Paediatr Scand. 1981 Mar;70(2):167–170. doi: 10.1111/j.1651-2227.1981.tb05536.x. [DOI] [PubMed] [Google Scholar]
  6. Epstein L. G., Goudsmit J., Paul D. A., Morrison S. H., Connor E. M., Oleske J. M., Holland B. Expression of human immunodeficiency virus in cerebrospinal fluid of children with progressive encephalopathy. Ann Neurol. 1987 Apr;21(4):397–401. doi: 10.1002/ana.410210413. [DOI] [PubMed] [Google Scholar]
  7. Goudsmit J., de Wolf F., Paul D. A., Epstein L. G., Lange J. M., Krone W. J., Speelman H., Wolters E. C., Van der Noordaa J., Oleske J. M. Expression of human immunodeficiency virus antigen (HIV-Ag) in serum and cerebrospinal fluid during acute and chronic infection. Lancet. 1986 Jul 26;2(8500):177–180. doi: 10.1016/s0140-6736(86)92485-2. [DOI] [PubMed] [Google Scholar]
  8. Ho D. D., Rota T. R., Schooley R. T., Kaplan J. C., Allan J. D., Groopman J. E., Resnick L., Felsenstein D., Andrews C. A., Hirsch M. S. Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome. N Engl J Med. 1985 Dec 12;313(24):1493–1497. doi: 10.1056/NEJM198512123132401. [DOI] [PubMed] [Google Scholar]
  9. Levy J. A., Shimabukuro J., Hollander H., Mills J., Kaminsky L. Isolation of AIDS-associated retroviruses from cerebrospinal fluid and brain of patients with neurological symptoms. Lancet. 1985 Sep 14;2(8455):586–588. [PubMed] [Google Scholar]
  10. Marshall D. W., Brey R. L., Cahill W. T., Houk R. W., Zajac R. A., Boswell R. N. Spectrum of cerebrospinal fluid findings in various stages of human immunodeficiency virus infection. Arch Neurol. 1988 Sep;45(9):954–958. doi: 10.1001/archneur.1988.00520330032007. [DOI] [PubMed] [Google Scholar]
  11. Mathiesen T., Sundqvist V. A., Albert J., Ohlsson E., Wahren B. Acid hydrolysis of serum samples to increase detection of HIV antigen. J Virol Methods. 1988 Dec;22(2-3):143–148. doi: 10.1016/0166-0934(88)90097-3. [DOI] [PubMed] [Google Scholar]
  12. McArthur J. C., Cohen B. A., Farzedegan H., Cornblath D. R., Selnes O. A., Ostrow D., Johnson R. T., Phair J., Polk B. F. Cerebrospinal fluid abnormalities in homosexual men with and without neuropsychiatric findings. Ann Neurol. 1988;23 (Suppl):S34–S37. doi: 10.1002/ana.410230712. [DOI] [PubMed] [Google Scholar]
  13. Portegies P., Epstein L. G., Hung S. T., de Gans J., Goudsmit J. Human immunodeficiency virus type 1 antigen in cerebrospinal fluid. Correlation with clinical neurologic status. Arch Neurol. 1989 Mar;46(3):261–264. doi: 10.1001/archneur.1989.00520390027010. [DOI] [PubMed] [Google Scholar]
  14. Price R. W., Brew B. J. The AIDS dementia complex. J Infect Dis. 1988 Nov;158(5):1079–1083. doi: 10.1093/infdis/158.5.1079. [DOI] [PubMed] [Google Scholar]
  15. Price R. W., Brew B., Sidtis J., Rosenblum M., Scheck A. C., Cleary P. The brain in AIDS: central nervous system HIV-1 infection and AIDS dementia complex. Science. 1988 Feb 5;239(4840):586–592. doi: 10.1126/science.3277272. [DOI] [PubMed] [Google Scholar]
  16. Resnick L., Berger J. R., Shapshak P., Tourtellotte W. W. Early penetration of the blood-brain-barrier by HIV. Neurology. 1988 Jan;38(1):9–14. doi: 10.1212/wnl.38.1.9. [DOI] [PubMed] [Google Scholar]

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