Background: 14-3-3 proteins have been detected in the cerebrospinal fluid (CSF) of patients with different neurological disorders as markers of neuronal damage. Since a previous study showed the prognostic value of this test in patients with bacterial meningitis, we wanted to evaluate its value in HIV-positive patients presenting with central nervous system (CNS) diseases.

Patients and Methods: We studied the trend of CSF level of 14-3-3 protein and its ζ isoform in 15 consecutive HIV patients presenting with various CNS diseases (cerebral lymphoma and cryptococcal meningitis were the most common). Lumbar Punctures were performed only according to clinical necessities; levels of 14-3-3 proteins were measured according to published methods and their total amount was quantified against control cases with hydrocephalus.

Results: Fifteen patients were enrolled: 10 male, mean age 39 and mean CD4 counts of 66 (13-226) cells ×106/litre. Cerebral lymphoma and cryptococcal meningitis were the most common diseases, respectively 40% and 33%. All patients showed positivity for 14-3-3 protein and its zeta isoform in CSF at admission. All who had a favourable outcome cleared the protein from their CSF in advance to the normalization of standard laboratories values (8/8). Seven non-survivors did not show clearance of the 14-3-3 protein or its zeta isoform. No difference emerged between total 14-3-3 protein and its zeta isoform in terms of quantity, association with a specific disease and prognostic value.

Conclusions: Detection of 14-3-3 protein and its ζ isoform in the CSF warrant further evaluation as a possible prognostic marker in HIV-positive subjects with CNS disorders and as a tool to guide treatment strategies.