Undetectable cerebrospinal fluid HIV RNA and β-2 microglobulin do not indicate inactive AIDS dementia complex in highly active antiretroviral therapy-treated patients

Objective: To assess whether nonelevated cerebrospinal fluid (CSF) markers could delineate inactive AIDS dementia complex (ADC) in patients receiving highly active antiretroviral therapy (HAART), using neuropsychologic performance change as an indicator of ADC stability. Methods: We used data from the abacavir (ABC) ADC trial (n = 78) and examined the patients' neuropsychologic performance change with the Reliable Change Index according to 3 cutoff groups: (1) CSF viral load (VL) < 100 copies/mL, (2) CSF beta-2 microglobulin (beta 2m) < 2.2 mg/L, and (3) CSF VL and CSF beta 2m below cutoffs. Results: CSF marker cutoff groups did not define neuropsychologic change. Linear regression showed that only CSF VL was a weak predictor of neuropsychologic performance change. Conclusion: HAART-treated ADC patients with baseline CSF markers of viral and immunologic inactivity did not necessarily have inactive ADC when followed over 12 weeks. More sensitive CSF markers to judge the activity of ADC are urgently needed, whereas the interpretation of these markers should be considered with caution in HAART-treated ADC patients.