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Johns Hopkins Medical Institutions, Baltimore, MD (Drs. McArthur, Griffin, Hoover, Selnes, Margolick, Farzadegan, and Saah, and T.E. Nance-Sproson)
University of California at Los Angeles, Los Angeles, CA (Dr. Miller)
Northwestern University, Chicago, IL (Dr. Cohen).
We measured serum and CSF ß2-microglobulin (ß2M) levels in HIV-1 seropositive individuals with and without dementia to determine the frequency and diagnostic utility of elevation of CSF ß32M. We compared 34 samples from 27 patients with HIV-1 dementia with 110 samples from 54 HIV-1 seropositive participants in the Multicenter AIDS Cohort Study, none of whom had progressive dementia. Neurosyphilis and CNS opportunistic processes were excluded in all subjects. We stratified the nondemented subjects by duration of HIV seropositivity and peripheral blood CD4 count. Compared with the nondemented group, demented subjects had significantly higher CSF total protein, IgG%, and CSF albumin/serum albumin ratios. A highly significant association was found between elevated CSF ß2M and reduced CD4 count (p < 0.0001). No significant differences were noted between the demented and nondemented groups in CSF WBC count or in the frequency of CSF HIV-1 isolation. The mean CSF ß2M was 1.9 mg/l in the nondemented subjects compared with 4.2 mg/l in those with dementia (p < 0.0001). We derived a cutoff of 3.8 mg/l from the distribution of CSF ß2M in the nondemented group. The determination of CSF ß2M had a sensitivity of 44%, specificity of 90%, and a positive predictive value of 88% for diagnosis of HIV dementia when compared with nondemented subjects with CD4 counts <200. In those without dementia, there was a strong correlation between serum and CSF ß2M (r = 0.50, p < 0.0001), but in demented subjects CSF ß2M was elevated independently of serum levels, suggesting that CSF ß2M is produced within the brain in HIV dementia. In the absence of CNS opportunistic processes, elevated CSF ß2M >3.8 mg/l is a clinically useful marker for HIV dementia.
Supported by National Institutes of Health grants AI 72634, NS 26643, OPGCRC 5 MO1 RR00722.
Presented in part at the 42nd annual meeting of the American Academy of Neurology, Miami Beach, FL, May 1990.
Address correspondence and reprint requests to Dr. Justin McArthur, Johns Hopkins Hospital, Meyer 6-109, 600 N Wolfe Street, Baltimore, MD 21205.
Received July 9, 1990. Accepted for publication in final form February 19, 1992.
The Multicenter AIDS Cohort Study Neuropsychologic Working Groups consist of the following investigators in addition to the cited authors— Baltimore, The Johns Hopkins Medical Institutions: Debbie Hasenauer, MS; Julie H. McArthur, RN, BSN; John Palenicek, PA-C, MPH; Sharon Metz, RN, MPH; Lisa Jacobson, ScM; and Alvaro Munoz, PhD; Chicago, Howard Brown Memorial Clinic-Northwestern University Medical School—Jerry Wesch, PhD; Joan S. Chmiel, PhD; and John P. Phair, MD; Los Angeles, University of California at Los Angeles Schools of Public Health and Medicine— Roger Detels, MD; Jan Dudley, MPH; Paul Satz, PhD; Wilfred Van Gorp, PhD; and Barbara Visscher, MD, DrPH; Pittsburgh, University of Pittsburgh-James T. Becker, PhD, and Charles Rinaldo, Jr, PhD; Bethesda, MD, National Institute of Allergy and Infectious Diseases—Lew Schrager, MD, and Sten Vermund, MD, PhD.
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