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July 1991

Acquired Immunodeficiency Syndrome Cerebrospinal Fluid Findings in Patients Before and During Long-term Oral Zidovudine Therapy

Author Affiliations

From the University of Washington, Seattle. Drs Tartaglione and Collier are now with the Division of Infectious Diseases, Dr Benedetti and Mr Mackay are now with the Department of Biostatistics, and Ms Cummings is a Health Care Specialist with the Harborview Medical Center, Seattle; and Drs Coombs and Corey are now with the Department of Virology, and Dr Opheim is with the Department of Laboratory Medicine at the D536 Childrens Hospital, Seattle.

Arch Neurol. 1991;48(7):695-699. doi:10.1001/archneur.1991.00530190041013

• Fifty-two patients with acquired immunodeficiency syndrome were enrolled in this study to evaluate the relationship between cerebrospinal fluid (CSF) zidovudine concentrations and neurologic and human immunodeficiency virus (HIV) culture findings. Paired HIV-CSF culture and neurologic measurements were available in 30 and 45 patients, respectively. Twenty-nine patients were assessable for zidovudine CSF concentrations. Patients underwent lumbar puncture and neurologic testing before and after 8 weeks or more of oral zidovudine therapy (600 to 1500 mg/d). After 8 weeks of therapy, the frequency of HIV isolation from CSF cultures was unchanged. Significant neurologic improvement by examination was noted in 61.5% (32/52) of the patients. The median CSF zidovudine concentration among 29 patients was 0.047 mg/L (range, 0.015 to 0.198 mg/L). No correlation between CSF zidovudine concentration, cumulative dose, or HIV isolation from CSF and persistence or resolution of neurologic symptoms or signs was observed. The mechanisms by which zidovudine improves neurologic function are unclear and appear unrelated to direct clearance of virus from CSF.

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