SHORT PAPERS Neurologic Abnormalities and Recovery of Human Immunodeficiency Virus from Cerebrospinal Fluid

Infectious human immunodeficiency virus (HIV) was recovered from 30 of 48 cerebrospinal fluid specimens from seropositive persons with and without neurologic symptoms or disease. Of 16 patients with only neurologic problems or other HIV-related conditions, but not the acquired immunodeficiency syndrome (AIDS), 11 had virus recovered; over half of those with AIDS also had virus isolated. Patients with headache or altered mental status had the highest recovery rate of HIV from cerebrospinal fluid. Although virus was primarily found in patients with detectable neurologic disease, it was also isolated from 5 of 8 patients with normal neurologic examinations. Two of these patients had fever alone. The presence of virus in cerebrospinal fluid did not necessarily correlate with isolation of virus from the serum. These findings suggest that HIV may at times replicate preferentially in the brain and that its presence may not immediately cause neurologic signs or symptoms. N E U R O L O G I C COMPLICATIONS are being recognized with increasing frequency in persons infected with the human immunodeficiency virus (HIV) (1). The evidence sug-gests that HIV itself is responsible for the subacute en-cephalopathy, polyneuropathy, and vacuolar myelopathy seen in the acquired immunodeficiency syndrome (AIDS) (2). Viral D N A or R N A has been found in brain specimens of AIDS patients who died of subacute encephalopathy (3). We isolated infectious HIV from ce-rebrospinal fluid and brain tissues from patients with AIDS or AIDS-related conditions who had various neu-rologic problems (4, 5). These observations have also been made by others (6). We report our attempts at viral isolation from the cere-brospinal fluid of 48 patients with AIDS, related condi-tions, or serologic evidence of HIV infection. Thirty pa-tients had the virus recovered from cerebrospinal fluid. Our detailed findings on 37 of 48 patients permitted an analysis of the relationship between cerebrospinal fluid virus recovery and neurologic findings