Absence of Cerebrospinal Fluid Signs of Neuronal Injury before and after Immediate Antiretroviral Therapy in Acute HIV Infection

Michael J. Peluso, Victor Valcour, Jintanat Ananworanich, Pasiri Sithinamsuwan, Thep Chalermchai, James L.K. Fletcher, Sukalya Lerdlum, Nitiya Chomchey, Bonnie Slike, Napapon Sailasuta, Magnus Gisslén, Henrik Zetterberg, Serena Spudich*, Nittaya Phanuphak, Nipat Teeratakulpisarn, Eugene Kroon, Donn Colby, Duanghathai Sutthichom, Somprartthana Rattanamanee, Peeriya MangyuSasiwimol Ubolyam, Pacharin Eamyoung, Suwanna Puttamaswin, Somporn Tipsuk, Putthachard Sangtawan, Mantana Pothisri, Robert O'Connell, Rapee Trichavaroj, Siriwat Akapirat, Bessara Nuntapinit, Nantana Tantibul, Hathairat Savadsuk, Vatcharain Assawadarachai, Nelson Michael, Jerome Kim, Merlin Robb, Linda Jagodzinski, Shelly Krebs, Silvia Kim, Sodsai Tovanabutra, Laura Napolitano, Molly Martell, Yolanda Lie

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background. It is unknown whether neuronal injury begins during acute human immunodeficiency virus (HIV) infection, and whether immediate initiation of combination antiretroviral therapy (cART) prevents neuronal injury. Methods. Cerebrospinal fluid (CSF) neurofilament light chain (NFL), ameasure of axonal injury, was assessed before and after cART initiation in individuals starting treatment during acute or chronic HIV infection. Nonparametric statistics examined relationships between NFL and disease progression, neuroinflammation, and cognitive performance. Results. Before treatment, subjects with acute infection had lower CSF NFL levels, with elevations for their age in 1 of 32 subjects with acute infection (3.1%) and 10 of 32 with chronic infection (31%) (P = .006). This persisted after cART initiation, with 1 of 25 acute (4%) and 4 of 9 chronic subjects (44%) showing elevated NFL levels (P = .01). In acute infection, pre-cART NFL levels were inversely correlated with proton magnetic resonance spectroscopic findings of Nacetylaspartate/ creatine in frontal gray matter (r = -0.40; P = .03), frontal white matter (r = -0.46; P = .01), and parietal gray matter (r = -0.47; P=.01); correlations persisted after treatment in the frontal white matter (r = -0.51; P = .02) and parietal gray matter (r = -0.46; P = .04). Conclusions. CSF NFL levels are not elevated in untreated acute HIV infection or after 6 months of immediately initiated cART but are abnormal in chronic HIV infection before and after treatment. In acute HIV infection, CSF NFL levels are inversely associated with neuroimaging markers of neuronal health.

Original languageEnglish
Pages (from-to)1759-1767
Number of pages9
JournalJournal of Infectious Diseases
Issue number10
StatePublished - 2015


  • Antiretroviral therapy
  • Magnetic resonance spectroscopy
  • Neurofilament light chain
  • Neuroinflammation
  • Neurological injury


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