The retrovirus that causes
acquired immune deficiency syndrome (
AIDS) is now designated the human immunodeficiency virus (HIV). The cerebrospinal fluid (CSF) of 27 children with
HIV infection was assayed for intra-blood-brain barrier (IBBB) synthesis of HIV-specific
antibodies and for the presence of HIV
antigen. In this cohort, 11 children had a progressive
encephalopathy (PE), 9 had a static
encephalopathy (SE), and 7 had normal neurological findings (N). IBBB synthesis of HIV-specific
antibodies was identified (using matched serum and CSF specimens) in 7 of 11 children with PE, 4 of 9 children with SE, and 2 of 7 children with N. HIV
antigen was found (using a highly sensitive solid-phase
enzyme immunoassay) in the CSF of 8 of 11 children with PE, none of the children with SE, and none of the 7 children with N. On the basis of these data, we conclude that: IBBB synthesis of
HIV antibodies indicates invasion of the central nervous system but may reflect prior or current
infection; and HIV
antigen in CSF indicates viral expression and correlates with the occurrence of PE. These findings strongly implicate HIV as the causative agent of PE in these children. The assay for HIV
antigen in the CSF may be of value in determining the prognosis of children with
HIV infection and for evaluating the efficacy of therapeutic agents against this retrovirus.