Cerebrospinal fluid analysis can support the clinical diagnosis of HIV-associated dementia, especially by excluding several central nervous system opportunistic infections, in particular cryptococcal meningitis.
The most frequent cerebrospinal fluid findings in HIV-associated dementia are the increase of total proteins and of the IgG fraction and index. A mononuclear pleocytosis may occur. The presence of the HIV core antigen p24 can be detected, although this finding is possible also in neurologically normal subjects. HIV RNA can be demostrated in the cerebrospinal fluid by using the polymerase chain reaction; the levels of HIV RNA in the cerebrospinal fluid correlate with the severity of dementia/9 Increased cerebrospinal fluid levels of neopterin, b 2-microglobulin and quinolinic acid (non-specific markers of immune activation), as well as of several cytokines (interleukin 1b, interleukin 6, tumour necrosis factor-a), have been reported, but may be detected also during central nervous system opportunistic infections.
As to differential diagnosis, Indian ink staining, cryptococcal antigen titres, and fungal culture can be decisive for the identification of cryptococcal meningitis. Other central nervous system opportunistic infections that can be identified by cerebrospinal fluid analysis include central nervous system tuberculosis, cytomegalovirus encephalitis, and neurosyphilis.
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