21st Conference on Retroviruses and Opportunistic Infections

Antiretroviral therapy (ART) begun soon after HIV infection dampened central nervous system (CNS) inflam-mation in a study of 26 recently infected people in San Francisco [1]. Cerebrospinal fluid (CSF) markers of inflammation returned to normal about 9 months after these people started ART, whereas ART begun during chronic infection has not had this effect. Markers of CNS inflammation typically remain abnormally high in people responding well to ART begun during chronic HIV infection. Julia Peterson (University of California, San Francisco) and collaborators con-ducted this study to determine how ART begun soon after HIV infection affects standard markers of inflamma-tion in the CNS. This longitudinal observational study involved antiretroviral-naive people with primary HIV infection, defined as infection within the year after transmission. These people started diverse ART regimens at different intervals after infection for reasons not related to this study. Peterson and colleagues analyzed data from 26 people with pretreatment blood and CSF samples as well as follow-up samples collected at intervals 6 to 12 months after they started ART. The investigators measured the following indicators:-- CSF/plasma albumin ratio and CSF protein, markers of blood-brain barrier disruption-- CSF white blood cells (WBC), a marker of CNS inflammation-- CSF and plasma neopterin, markers of immune activation, par-ticularly macrophage activatio