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Immediate initiation of cART is associated with lower levels of cerebrospinal fluid YKL-40, a marker of microglial activation, in HIV-1 infection.

Journal article
Authors Michael J Peluso
Victor Valcour
Nittaya Phanuphak
Jintanat Ananworanich
James Lk Fletcsher
Thep Chalermchai
Shelly J Krebs
Merlin L Robb
Joanna Hellmuth
Magnus Gisslén
Henrik Zetterberg
Serena Spudich
Published in AIDS (London, England)
Volume 31
Issue 2
Pages 247–252
ISSN 1473-5571
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Biomedicine, Department of Infectious Medicine
Pages 247–252
Language en
Keywords acute HIV; central nervous system; cerebrospinal fluid; combination antiretroviral therapy; HIV; microglia; microglial activation; neuroinflammation; neuronal injury; neuropathogenesis; YKL-40, ALZHEIMERS-DISEASE; INFLAMMATION; BIOMARKER; INJURY
Subject categories Neurochemistry


To characterize cerebrospinal fluid (CSF) YKL-40, a unique biomarker that reflects activation of microglial cells, in acute (AHI) and chronic HIV-1 infection (CHI) and to determine the effect of treatment initiation on levels of this marker.Cross-sectional study of two groups of HIV-infected participants at baseline and follow-up timepoints.AHI (n = 33) and CHI (n = 34) participants underwent CSF and blood sampling before treatment initiation with combination antiretroviral therapy (cART) and at follow up on cART in a subset of these individuals (6 months in AHI participants [n = 24], 1 year in CHI participants [n = 10]). Measured parameters were analyzed at each timepoint. Analyses employed Mann-Whitney tests and Spearman correlations.Baseline median YKL-40 was higher in CHI than AHI (96844 versus 80754 ng/L; p = 0.011). Elevations in the CHI group relative to the AHI group persisted at follow-up despite treatment (87414 versus 66130 ng/L; p = 0.003). In untreated CHI, YKL-40 correlated with neopterin (r = 0.51, p = 0.0025), chemokine (CXC-motif) ligand-10 (r = 0.44, p = 0.011), and neurofilament light chain (r = 0.56, p = 0.0008) in CSF.This study is the first to describe the dynamics of CSF YKL-40 in two groups of HIV-infected individuals before and after cART and demonstrates the value of this marker in understanding HIV neuropathogenesis. The results suggest the utility of further exploring the prognostic value of YKL-40, particularly in individuals with early HIV infection or those initiating treatment during CHI.

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