Brouwers P, Pizzo P, Moss H, Wolters P, El-Amin D, Poplack D, Markey S, Heyes M; International Conference on AIDS.

Int Conf AIDS. 1991 Jun 16-21; 7: 190 (abstract no. W.B.2033).

Pediatric Branch, National Cancer Institute, Bethesda, MD 20892, USA

OBJECTIVE: Neurologic abnormalities are frequent in children with HIV infection. It may sometimes be difficult however to differentiate HIV-related CNS effects from other confounding medical and environmental factors. Increased CSF levels of quinolinic acid (QUIN) have been observed in adult HIV patients, particularly those with dementia. To determine whether QUIN levels were also increased in children, and to evaluate its potential usefulness as a marker of CNS dysfunction, we examined CSF QUIN along with objective measures of cognitive function. METHODS: Age-appropriate IQ measures and CSF were examined in 40 children with symptomatic HIV disease (mean age 4.6+/-0.6 yrs), who were either previously untreated or on anti-retroviral treatment (ART) less than 1 month. These measures were repeated in 16 patients following 6 mos of ART. Controls were 16 cancer patients (mean age 9.6+/-1.2 yrs). QUIN was measured by gas chromatography/mass spectrometry. RESULTS: CSF QUIN levels were significantly elevated (less than .0001) in HIV infected children (92.9+/-17.4nM) compared to controls (18.7+/-2.8 nM). Initial full scale IQ (FIQ) of 80.8+/-3.8 was below normal (=100; p less than .001) Stepwise regression analysis showed that FIQ and route of infection were significantly correlated with CSF QUIN (r=0.48, p less than .01) and FIQ and age with LOG CSF QUIN (r=0.44, p less than .02). Gender and socio-economic status were non-contributory. Following ART CSF QUIN declined in 15/16 patients, from 89.2 to 30.7 (less than .005) while FIQ increased in 15/16 from 74.8 to 87.2 (less than .001). However the relation between change in QUIN and change in FIQ (r=0.-23, p greater than .35) was not significant. In these 16 patients the relation between FIQ and QUIN, present at baseline (less than .06), disappeared after ART (greater than .43). CONCLUSION: The correlation between CSF QUIN and FIQ prior to treatment, the fact that QUIN falls and FIQ improves with ART and that ART attenuates the relation between QUIN and FIQ, suggests that QUIN may be a marker for CNS dysfunction in HIV infected children. QUIN, an exictotoxin and L-tryptophan metabolite may affect the CNS via disruption of N-methyl-D-asparate receptors, including synaptogenesis. Thus together with cognitive assessment QUIN determination may be useful both diagnostically and as a measure of therapeutic response.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Adult
• Central Nervous System Diseases
• Child
• HIV Infections
• HIV Seropositivity
• Humans
• Quinolinic Acid
• Simian Acquired Immunodeficiency Syndrome
• Tryptophan
• abnormalities
• cerebrospinal fluid

Other ID:

• 3203391

UI: 102192615

From Meeting Abstracts