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Carlo Ferrarese, MD, PhD
University of Milan Ospedale San Gerardo Monza, Italy

JAMA. 1997;277(24):1931.

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In Reply.

—Drs Gurwitz and Kloog raise some points regarding possible alternative interpretations of our data. Human immunodeficiency virus—related encephalitis is present in all patients with AIDS-related dementia, and its severity is correlated with the extent of viral infection and degree of dementia.¹ For this reason, we believe that an increased glutamate level in CSF can be directly explained by interaction of viral proteins or factors from virus-infected cells (cytokines, free radicals, and nitric oxide) with glutamate transporters within the central nervous system. The alternative explanation of increased CSF glutamate levels as a reflection of elevated plasma levels appears less likely, for several reasons. Plasma glutamate levels were similarly elevated in AIDS patients with and without dementia,² and BBB disruption also may be present in nondemented HIV-positive patients who have normal CSF glutamate levels.³ Moreover, although glutamate levels are normally 10 times higher in blood than in CSF, in . . . [Full Text PDF of this Article]

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