Estimation of virological and immunological parameters in subjects from South India infected with human immunodeficiency virus type 1 clade C and correlation of findings with occurrence of neurological disease

Abstract

Several studies carried out in Western countries have demonstrated that a number of virological and immunological markers such as viral loads, cytokines, beta(2)-microglobulin, neopterin, etc., are elevated in the serum and cerebrospinal fluid (CSF) of human immunodeficiency virus (HIV)-infected individuals with neurological disease. The neurological manifestations of HIV infection noted in Indian patients is different from those reported in Western countries. Moreover, few studies have investigated the role of virological and immunological parameters with respect to the progression of HIV-1 clade C infection in India. In this study, we measured virological (HIV-1 RNA levels) and immunological parameters (CD4 cell count and inflammatory markers) in the plasma and CSF of HIV-1-infected neurologically asymptomatic and symptomatic (with opportunistic infections and/or dementia) subjects. By using clade-specific polymerase chain reaction (PCR), we ascertained that all samples used for the study were infected with HIV-1 clade C. Among the various laboratory parameters evaluated, high viral loads in the CSF, low CD4 counts, and higher levels of interleukin (IL)-1alpha, IL-6, tumor necrosis factor alpha (TNFalpha), beta(2)-microglobulin, and neopterin were noted in HIV-infected subjects with neurological disease as compared to asymptomatic subjects. These data suggest that the markers evaluated in plasma and CSF samples correlated with occurrence of neurological disease in symptomatic individuals as compared to asymptomatic HIV infected subjects.

A guide to interpretation of neuroimmunological biomarkers in the combined antiretroviral therapy-era of HIV central nervous system disease

“…In addition, levels decrease with antiretroviral treatment. 29 This finding has been replicated in HIV-1 clade C. 19 Elevated CSF neopterin correlates with HIV dementia severity. 29 In patients with advanced HIV disease, elevated levels are associated with increased risk of dementia.…”

“…18 The generalizability of β2M elevation in neurological involvement of HIV-1 Clade C has recently been described. 19 However, it is usually not useful in CART-treated patients.…”

Global NeuroAIDS Roundtable

“…However, it was shown that in India, occurrence of neurocognitive deficits among HAART naïve, HIV-1 clade C-infected individuals was similar to that occurring in the West with HIV-1 clade B infection (Gupta et al 2007). It was also reported that inflammatory cytokines and virological markers were significantly increased in cerebral spinal fluid (CSF) of infected individuals (Kamat et al 2009). A critical gap for research in India is the lack of normative data from HIV negative comparison groups.…”

Current Status of Research on HIV Epidemic, Pathogenesis, Management and Prevention in India

“…The plasma viral load estimation is the best indicator of how active HIV is in the patient's body, whereas the absolute CD4 cell count is more predictive of clinical disease progression. In the beginning of HIV epidemic, various other markers such as b2 microglobulin, neopterin and various cytokines have been considered as the surrogate markers to monitor the disease progression [59][60][61][62][63]. Although nonspecific, these makers gave fairly good idea about the immune activation and thus the disease progression in HIV infected individuals.…”