Role of molecular biological methods in etiological decoding of central nervous system lesions in patients with HIV infection

Introduction. The problem of severe CNS lesions in patients with HIV infection is relevant. Objective of the study. Description of the spectrum of CNS lesions, determination of the diagnostic value of the presence and different concentrations of HIV RNA and DNA agents of secondary diseases in CSF and blood to verify the nature of encephalitis in patients with HIV infection. Materials and methods. 5485 patients with HIV infection were examined, 1310 with CNS damage. CSF (1667), blood serum (743) and blood plasma (3623) samples with the determination of pathogens DNA and HIV RNA were examined. Statistical software packages Statistica v. 10.0 and SPSS v. 20, programming language R, conjugacy tables with Pearson χ2 criterion, ROC analysis were used. Results. The spectrum of secondary neurological pathologies in patients with HIV infection, the frequency of detection and quantitative characteristics of HIV RNA, DNA of pathogens of neuroinfections in CSF are shown. The association between the amount of HIV RNA in the blood and CSF is statistically significant, but in 7.5% of cases, the concentration of HIV RNA in the CSF exceeded > 10 times the plasma value. Due to the high diagnostic sensitivity of the test, the absence of DNA of secondary disease pathogens and HIV RNA CSF excludes their role in the development of encephalitis. The diagnostic specificity of qualitative DNA determination of T. gondii, M. tuberculosis, C. neoformans, JCPyV is 100%. It is necessary to quantify HIV RNA, CMV DNA, EBV DNA, HHV-6 A/В DNA, Candida fungi in the CSF to confirm the etiology of the CNS lesion. Determination of CMV DNA in CSF at a concentration of > 16,600 copies/mL, blood leukocytes > 4.65 lg copies/105 cells, blood plasma > 62,700 copies/mL with 95% probability confirms CMV- etiology of encephalitis. Conclusion. Qualitative and quantitative determination of DNA of secondary disease agents and HIV RNA in CSF is crucial in timely decoding of the nature of neurological pathology in patients with HIV infection