CEREBROSPINAL-FLUID BETA-2-MICROGLOBULIN IN PATIENTS WITH AIDS DEMENTIA COMPLEX - AN EXPANDED SERIES INCLUDING RESPONSE TO ZIDOVUDINE TREATMENT

Objective: To determine the relationship between cerebrospinal fluid (CSF) beta-2-Microglobulin (beta-2M) and severity of AIDS dementia complex (ADC), and between CSF beta-2M and response of ADC to zidovudine. Design: A prospective study. Setting. Tertiary referral hospital. Patients, participants: Seventy-eight patients with varying stages of ADC were selected from a subgroup of a cohort of HIV-seropositive patients who are being studied prospectively for the neurological complications of HIV-1 infection. To enter our study, patients had to have an ADC stage of at least 0.5 (equivocal symptoms or abnormal neurological signs in the absence of functional impairment). A control group of 11 HIV-1-seropositive, neurologically normal patients was chosen randomly from the patients followed in the Multicenter AIDS Cohort Study. Interventions: Patients were assessed neurologically and neuropsychologically and computed tomography of the brain and CSF studies were performed. Main outcome measures: Patients were staged according to severity of ADC on clinical criteria. Neuropsychological test scores were converted to an impairment score. CSF beta-2M was quantified in both serum and CSF of all patients and in 10 patients with pre- and post-zidovudine assessments. Results: There was a high correlation between CSF beta-2M concentration and severity of ADC (P < 0.0001); treatment with zidovudine significantly reduced these concentrations (P = 0.013). CSF beta-2M concentration was independent of CSF white-cell count and blood-brain barrier impairment. Other CSF changes in the same patients (including blood-brain barrier permeability to albumin, intrathecal synthesis of immunoglobulin G and HIV-1-p24-antigen levels) were less useful as objective correlates of ADC severity and response to zidovudine therapy. Conclusions: CSF beta-2M may be a valuable marker of ADC severity and response to antiviral therapy.