The Particulars: Research has shown that neurofilament light chain (NFL) in cerebrospinal fluid (CSF) is a sensitive marker of axonal injury. CSF NFL is often higher in patients with HIV-associated dementia and some individuals who are neuro-symptomatic in both early and late stages of HIV infection. It has yet to be determined if axonal injuries can be detected during acute HIV and if initiating combination antiretroviral therapy (cART) at this time can lower CSF NFL when compared with starting cART during chronic HIV. Data Breakdown: For a study, researchers compared NFL levels of patients with acute HIV with those of patients with chronic HIV at baseline and at 24 and 96 weeks after initiating cART. After at least 6 months of sustained cART, acute HIV patients had lower average CSF NFL levels than chronic subjects. Only 3.9% of acute HIV subjects had CSF NFL levels above the upper limit of normal for age, compared with a 50.0% rate for chronic subjects.
Take Home Pearl: Initiation of cART in patients with acute HIV appears to mitigate the development or neuronal injury when compared with initiating this therapy in patients with later stages of the infection.