Cerebrospinal fluid biomarkers and HIV-associated neurocognitive disorders in HIV-infected individuals in Rakai, Uganda

Mahsa Abassi, Bozena M. Morawski, Gertrude Nakigozi, Noeline Nakasujja, Xiangrong Kong, David B. Meya, Kevin Robertson, Ronald Gray, Maria J. Wawer, Ned Sacktor, David R. Boulware

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


In the USA, increased cerebrospinal fluid (CSF) inflammatory cytokines have been observed in antiretroviral therapy (ART)-naive, HIV-seropositive individuals with HIV-associated neurocognitive disorder (HAND). We characterized the relationship between HAND and CSF biomarker expression in ART-naive, HIV-seropositive individuals in Rakai, Uganda. We analyzed CSF of 78 HIV-seropositive, ART-naive Ugandan adults for 17 cytokines and 20 neurodegenerative biomarkers via Luminex multiplex assay. These adults underwent neurocognitive assessment to determine their degree of HAND. We compared biomarker concentrations between high and low CD4 groups and across HAND classifications, adjusting for multiple comparisons. Individuals with CD4 <200 cells/μL (N = 38) had elevated levels of CSF Interleukin (IL)-2, IL-12, granulocyte-macrophage colony-stimulating factor (GM-CSF), TNF-α, matrix metalloproteinase (MMP)-1, MMP-7, and S100 calcium-binding protein B (S100B) and lower levels of amyloid β42. Individuals with CD4 351–500 cells/μL (N = 40) had significantly higher CSF levels of interleukin (IL)-1β, amyloid β42, and soluble receptor for advanced glycation end products (sRAGE). Increasing levels of S100B, platelet-derived growth factor-AA (PDGF-AA), brain-derived neurotrophic factor (BDNF), and sRAGE were associated with decreased odds of mild neurocognitive disorder (n = 22) or HIV-associated dementia (n = 15) compared with normal function (n = 30) or asymptomatic neurocognitive impairment (n = 11). Increased levels of interferon (IFN)-γ were associated with increased odds of mild neurocognitive impairment or HIV-associated dementia relative to normal or asymptomatic neurocognitive impairment. Proinflammatory CSF cytokines, chemokines, and neurodegenerative biomarkers were present in increasing concentrations with advanced immunosuppression and may play a role in the development of HAND. The presence of select CNS biomarkers may also play a protective role in the development of HAND.

Original languageEnglish (US)
Pages (from-to)369-375
Number of pages7
JournalJournal of neurovirology
Issue number3
StatePublished - Jun 1 2017

Bibliographical note

Funding Information:
The authors thank the support from the National Institutes of Health and Fogarty International Center (R01MH099733, R01NS086312, T32AI055433, U01AI089244, and R25TW009345; R01AI110324; U01AI10031) and the Bill and Melinda Gates Foundation (22006).

Publisher Copyright:
© 2016, Journal of NeuroVirology, Inc.


  • Cytokine expression
  • Dementia
  • HIV-associated neurocognitive disorders
  • Inflammation
  • Neurodegenerative biomarkers


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