Effect of antiretroviral treatment on blood-brain barrier integrity in HIV-1 infection
Artikel i vetenskaplig tidskrift, 2021

Background Blood-brain barrier (BBB) injury is prevalent in patients with HIV-associated dementia (HAD) and is a frequent feature of HIV encephalitis. Signs of BBB damage are also sometimes found in neuroasymptomatic HIV-infected individuals without antiretroviral therapy (ART). The aim of this study was to investigate the integrity of the BBB before and after initiation of ART in both neuroasymptomatic HIV infection and in patients with HAD. Methods We determined BBB integrity by measuring cerebrospinal fluid (CSF)/plasma albumin ratios in archived CSF samples prior to and after initiation of ART in longitudinally-followed neuroasymptomatic HIV-1-infected individuals and patients with HAD. We also analyzed HIV RNA in blood and CSF, IgG Index, CSF WBC counts, and CSF concentrations of beta 2-micoglobulin, neopterin, and neurofilament light chain protein (NfL). Results We included 159 HIV-infected participants; 82 neuroasymptomatic individuals and 77 with HAD. All neuroasymptomatic individuals (82/82), and 10/77 individuals with HAD, were longitudinally followed with a median (interquartile range, IQR) follow-up of 758 (230-1752) days for the neuroasymptomatic individuals, and a median (IQR) follow-up of 241 (50-994) days for the individuals with HAD. Twelve percent (10/82) of the neuroasymptomatic individuals and 80% (8/10) of the longitudinally-followed individuals with HAD had elevated albumin ratios at baseline. At the last follow-up, 9% (7/82) of the neuroasymptomatic individuals and 20% (2/10) of the individuals with HAD had elevated albumin ratios. ART significantly decreased albumin ratios in both neuroasymptomatic individuals and in patients with HAD. Conclusion These findings indicate that ART improves and possibly normalizes BBB integrity in both neuroasymptomatic HIV-infected individuals and in patients with HAD.

Albumin ratio



Antiretroviral therapy


Cerebrospinal fluid


Birgitta Anesten

Göteborgs universitet

Henrik Zetterberg

Göteborgs universitet

Staffan Nilsson

Chalmers, Matematiska vetenskaper, Tillämpad matematik och statistik

Bruce J. Brew

St Vincent's Hospital

Dietmar Fuchs

Medizinische Universität Innsbruck

Richard W. Price

University of California at San Francisco

Magnus Gisslen

Göteborgs universitet

Aylin Yilmaz

Göteborgs universitet

BMC Neurology

14712377 (eISSN)

Vol. 21 1 494









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