Thesis (M.Sc. (Clinical Tropical Medicine))--Mahidol University, 1983.

Corticotropin-releasing factor (CRF) is the primary hormone of the hypothalamo-pituitary adrenal axis (HPA-axis). In addition to its endocrine function, it has been proposed that CRF acts as a neurotransmitter. The widespread distribution of CRF immunoreactivity and CRF receptors in the rat central nervous system (CNS) supports this theory. Immunohistochemical studies have demonstrated high levels of CRF immunoreactivity the rat hypothalamus, a brain region involved in the regulation and integration of a variety of endocrine and autonomic homeostatic mechanisms. CRF has been shown to be involved in a number of these activities such as blood pressure control, food and water intake, behaviour and emotional integration. Many of these activities demonstrate progressive dysfunction as ageing proceeds. The aim of this thesis was to investigate the regulation of CRF in the rat CNS, particularly over the period of maturation and ageing. Tissue extraction and peptide radioimmunoassay (RIA) techniques were developed in order to measure regional CRF concentrations as a function of age in the rat CNS. Seven brain regions were examined including the hypothalamus, pituitary, medulla oblongata, pons, cerebral cortex, cerebellum and midbrain. Three age ranges were investigated: 3 – 4 weeks, 4 – 5 months and 14 – 18 months, representing young, mature and old age groups. Data for the tissues of individual rats from each age group were analysed using one-way analysis of variance (ANOVA) with post-hoc Scheffé tests (SPSS Release 6 for Windows, 1989 – 1993). CRF were detected in measurable quantities in all brain regions examined. Different age-related patterns of change were observed in each brain region. CRF concentrations (ng/g tissue) were highest in the pituitaries of young rats and were significantly reduced over the period of maturation (P< 0.05). However, the high CRF concentration of the young rat pituitary was likely to be a factor of the smaller tissue mass. Although the absolute CRF content (ng/tissue) of this tissue appeared to decline with maturation and ageing, the reduction was not significant (P>0.05). Therefore the pituitary of the young rat was relatively enriched with CRF per gram tissue. The highest CRF concentration in mature and aged rats was measured in the hypothalamus, in accordance with previous immunohistochemical studies. Hypothalamic CRF concentrations (ng/g tissue) demonstrated no significant alterations with maturation and ageing. The absolute CRF content (ng/tissue) of the hypothalamus was significantly less in the young rat compared to mature and aged animals, however this was accompanied by a smaller tissue mass (P<0.05). The CRF concentrations (ng/g tissue) of the rat cerebral cortex and medulla oblongata demonstrated significant reduction with advancing age (P<0.05), however in both cases this appeared to be due to significant increases in mean tissue mass. The absolute CRF content of these tissues (ng/tissue) were not significantly different over the period of maturation and ageing (P>0.05). CRF concentration (ng/g tissue) and absolute content (ng/tissue) of the pons demonstrated a trend to increase with advanced age in the rat, however this was not significant in both cases (P>0.05). Of interest were the significant increases observed in the CRF concentrations of the cerebellum and midbrain (ng/g tissue with advanced ageing (P<0.05). Significant increases were also observed in the mean tissue mass and absolute CRF content (ng/tissue) of these regions in aged rats (P<0.05). These findings perhaps indicate increased CRF synthesis and or decreased CRF turnover in these tissues with advancing age. The second stage of these studies examined age-related alterations in basal and potassium-stimulated hypothalamic CRF and overflow over the period of maturation and ageing in the rat, and required the preliminary development of an in vitro tissue superfusion system. The concomitant release of the co-modulatory compound, neuropeptide Y (NPY) was also measured. NPY has been shown to positively regulate CRF release and gene expression in the hypothalamus. In addition, NPY has been demonstrated to be involved in a number of hypothalamic activities, including blood pressure control and food intake regulation. Hypothalamic superfusion data were analysed using one factor repeated measures ANOVA (SPSS Release 6 for Windows, 1989-1993) followed by least significant difference tests ( Snedecor and Cochran, 1967) to enable both time and age comparisons. Basal hypothalamic CRF overflow was unaltered with maturation and ageing in the rat. Potassium stimulation (56 mM) elicted a significant 2 – 3 fold increase in hypothalamic CRF overflow across age groups (P<0.05). Stimulated hypothalamic CRF overflow was significantly greater in the young rat compared to the mature and aged animals (P<0.05). The enhanced response to depolarizing stimulus was observed at an age when the absolute CRF content of the hypothalamus was significantly less that of other age groups. It is possible that the enhanced responsiveness of the young rat may be of survival advantage in life threatening situations. Basal hypothalamic NPY overflow was much less than that of CRF, and potassium stimulation resulted in a very different age-related profile. The hypothalamic NPY response to depolarization was significantly reduced in the young rat and declined significantly with advanced ageing (P<0.05). The contrasting profiles of stimulated CRF and NPY overflow may indicate the activity of alternative regulatory factors present in the hypothalamus, whose activity may also be affected in an age-related manner. The final stage of these studies examined the nature of NPY modulation of hypothalamic CRF overflow in the mature rat. The facilitatory effect of NPY on hypothalamic CRF overflow was confirmed. The application of NPY (0.1 µM) significantly increased CRF overflow approximately 4 fold of basal (P<0.05). In addition, the role of the NPY-Y1 receptor was investigated by the prior application of Y1 receptor antagonists, GW1229 (0.05 µM). At this concentration GW1229 significantly reduced hypothalamic CRF overflow induced by perfusion with NPY (0.1 µm), P<0.05. It was concluded the Y1 receptor does have a role in the regulation of hypothalamic CRF overflow by NPY.

Los virus de influenza aviar de alta patogenicidad (IAAP) causan una enfermedad muy severa en pollos, los cuales frecuentemente inducen lesiones en el sistema nervioso central (SNC). Esta tesis recoge los resultados de tres estudios que se llevaron a cabo para determinar el mecanismo de patogénesis y neurotropismo, así como establecer la ruta de entrada al SNC para un virus H7N1 IAAP. En el primer estudio se estableció un modelo animal de infección en pollos libres de patógenos específicos, que consistía en la inoculación intranasal con el virus H7N1 IAAP. Para establecer este modelo, se utilizaron tres diferentes dosis del virus, obteniendo que las dosis más altas producen una enfermedad similar a la reportada para otros virus de IAAP. Además, se observó que las dosis más bajas causan infección demostrada porque con las dosis más bajas, el virus es hallado en muestras de tejido, muestras de heces y secreciones respiratorias. Adicionalmente, se pudo comprobar el alto neurotropismo del virus, ya que aún en pollos inoculados con bajas dosis el RNA viral es hallado en el CNS. La viremia fue detectada a un día post infección (dpi), sugiriendo que está podría ser la vía de diseminación al SNC. En el segundo estudio, se determinó la distribución topográfica del antígeno viral en el SNC durante las primeras horas post infección, lo cual permitió determinar que el virus se disemina de forma simétrica y bilateral en núcleos neurales del diencéfalo, mesencéfalo y rombencéfalo. La distribución del antígeno viral indica que el bulbo olfatorio y los nervios periféricos están involucrados en el proceso de invasión del SNC. El hallazgo de receptores aviares y humanos en las células endoteliales explica porque estas células son tan sensibles a la infección. El RNA viral fue hallado en el líquido cerebro espinal el primer dpi, lo que indica que el virus atraviesa la barrera hemato-encefálica (BHE). En el tercer estudio, la alteración de la BHE inducido por el virus H7N1 IAAP fue demostrado usando tres diferentes métodos que incluye la perfusión intracardial de Azul de Evans, la detección de la extravasación de la proteína del suero IgY, y evaluación del patrón de tinción con el marcador de las uniones fuertes de la BHE, ZO-1 y claudin-1. El antígeno viral fue observado a las 24 hpi en las células endoteliales, mientras que el daño de la BHE fue observado a las 36 hpi y 48 hpi. En resumen, se puede afirmar que el virus H7N1 IAAP se disemina por la vía hematógena durante las primeras horas pi, posiblemente favorecido por la presencia de receptores en las células endoteliales del sistema nervioso central, y poco después daña la BHE durante las primeras horas de infección como se demuestra por la presencia de extravasación del azul de Evans and IgY del suero. / Highly pathogenic avian influenza viruses (HPAIV) cause a very severe systemic disease in chickens, in which is also frequent to find central nervous system (CNS) lesions. In this thesis, three studies were undertaken in order to determine the mechanism of pathogenesis, the neurotropism and establish the route of entry into the CNS use for a H7N1 HPAI virus. In the first study, an animal model was set up that consisted of SPF chickens inoculated intranasally with the H7N1 HPAI virus. To do that, three different doses were used, obtaining that the highest dose induced a disease similar to the produce by other HPAI viruses, moreover, it was also observed that very low doses also cause infection demonstrated because viral RNA was found in tissues samples, faeces and respiratory secretions. Besides, the high neurotropism of this virus was demonstrated because still in chickens inoculated with low doses, viral RNA is found in the brain. Viremia was detected at one dpi, which indicated that the bloodstream is the pathway of viral spreading to the brain. In the second study, the topographical distribution study of the viral antigen during the first dpi was determined, which allow to determine that the virus disseminates showing a symmetrical and bilateral pattern in the diencephalon, mesencephalon and rhombencephalon, whereas in the telencephalon and cerebellum it was multifocal and random. Viral antigen distribution indicates that the olfactory bulb (OB) and peripheral nerves are not involved in the process of virus invasion into the brain. Avian and human influenza receptors were found in endothelial cells which explain why these cells are so sensitive to the infection. Viral RNA was found in cerebrospinal fluid (CSF) at one dpi, indicating that the virus was able to cross blood brain barrier (BBB). In the third study, the disruption of the BBB induce by the H7N1 HPAI was demonstrated using three different methods that include the intracardial perfusion of the tracer Evans blue (EB), detection of the extravasation serum IgY, and evaluation of the pattern of staining of the tight junction proteins ZO-1 and claudin-1. Viral antigen can be observed as early as 24 hpi in the endothelial cells, whereas disruption was detected at 36 and 48 hpi. In summary, it can be asserted that this H7N1 HPAIV disseminates via the haematogenous route early during the infection, favored by the presence of abundant receptors on the CNS endothelial cells, and soon after it disrupts the BBB during the first hours of infection as demonstrated by the presence of EB and serum IgY extravasation.

Introdução A preocupação crescente com as possíveis consequências da replicação viral no sistema nervoso central mostra a necessidade da detecção do HIV no compartimento cerebral. O teste de PCR em tempo real desenvolvido pela Abbott, o Abbott m2000 RealTime HIV-1 (m2000rt), quantifica a carga viral do HIV em amostras de sangue com um procedimento efetivo e de baixo custo no nosso país, por isso é adotado como método padrão pelo Ministério da Saúde, mas não é utilizado em amostras de líquor. O ensaio produzido pela Roche, o COBAS TaqMan HIV-1, version 2 (COBAS v2.0), é o método de PCR em tempo real que tem sido amplamente utilizado para detectar a carga viral do HIV no compartimento cerebral. No entanto, esse método ainda não foi validado para esse propósito e seu custo pode ser uma limitação em diversas regiões com baixos recursos. Objetivos Considerando que não há uma metodologia padronizada para essa situação específica (detecção do HIV no líquor), nós conduzimos esse estudo a fim comparar os desempenhos dos testes m2000rt e COBAS v2.0, na tentativa de propôr um método alternativo e com baixos custos ao mais utilizado nesse contexto (COBAS v2.0). Métodos O estudo foi realizado no período de maio de 2015 a julho de 2016. O cálculo do tamanho da amostra foi baseado em dados de um estudo piloto que revelaram ser necessário um número mínimo de 37 amostras, para detectar uma diferença de 0,20 log10 na carga viral, com um coeficiente de correlação de 0,979 e um poder de 90%. Essa equação permitiria uma perda de 10%. As amostras de líquor foram coletadas consecutivamente a partir de 37 pacientes HIV positivos atendidos no Hospital de Clínicas de Porto Alegre/RS. Os métodos foram processados de acordo com o proposto pelo fabricante para utilização com amostras de plasma. Pequenas modificações foram necessárias no teste em estudo (m2000rt) para neutralizar qualquer diferença metodológica e evitar vieses de mensuração: o congelamento das amostras foi realizado a -20ºC até o momento da análise. O ensaio COBAS v2.0 foi utilizado como referência, uma vez que é o método mais utilizado. Foram realizadas análises quantitativas com resultados que estavam dentro da faixa linear em ambos os métodos (n = 18). Para tornar os métodos comparáveis, adotou-se o limite de detecção do ensaio m2000rt para ambos (40 cp/mL ou 1,60 log10 cp/mL). Os resultados abaixo do limite de detecção foram apresentados como uma variável categórica, uma vez que não são quantificáveis. O coeficiente de correlação de Pearson foi utilizado para comparar os métodos. A normalidade das variáveis foi então resumida calculando o viés estimado pela diferença média "đ " e o desvio padrão das diferenças realizadas pelo teste t para amostras pareadas. Com base na falta de normalidade dos métodos, o grau de concordância dos resultados das cargas virais de HIV foi analisado pelo índice Kappa. Esse estudo foi aprovado pelo comitê de ética do Hospital de Clínicas de Porto Alegre (RS)/ Brasil, registrado na Plataforma Brasil como sendo CAAE: 35072214.7.0000.532. Conclusão Em conclusão, o teste m2000rt que foi modificado para este ensaio mostrou boa concordância e correlação com o teste mais utilizado nesse contexto e pode ser considerado um método alternativo com resultados semelhantes ao COBAS v2.0 e baixos custos na quantificação da carga viral do HIV no líquor. Sugerimos, principalmente em locais onde este método está prontamente disponível com uma relação custo-benefício aceitável, que o exame m2000rt deva ser realizado. / Introduction Growing concern about possible consequences of viral replication in the central nervous system shows the need for HIV detection in the cerebral compartment. The real time PCR test developed by Abbott, Abbott RealTime m2000 HIV-1 (m2000rt) quantifies HIV viral load in blood samples effectively and with low costs Brazil. It is the standard method by the Brazilian Ministry of Health, but it has never been utilized to measure HIV in cerebrospinal fluid samples. The assay produced by Roche, COBAS TaqMan HIV-1, version 2 (COBAS v2.0) is the real-time PCR method that has been widely used to detect HIV viral load in cerebral compartment. However, this method has not yet been validated for this purpose and its cost may be a limitation in several regions in the world with low resources. Objective Taking under consideration that there was no standard methodology for this specific situation (detecting HIV in cerebrospinal fluid), we conducted this study to compare the performances of the m2000rt and COBAS v2.0 assays, to propose an alternative and low-cost method to more used in this context (COBAS v2.0). Methods The study was conducted from May 2015 to July 2016. The sample size calculation was based on data from a pilot trial that revealed that a minimum of 37 samples would be needed to detect a difference of 0.20 log10 in viral load, with a correlation coefficient of 0.979 and a 90% power. This equation would allow a 10% lost. CSF samples were collected consecutively from 37 HIV-positive patients seen at Hospital de Clínicas, Porto Alegre, RS. Methods were processed according to proposed by the manufacturer for utilization with plasma samples. Small modifications were necessary in the study test (m2000rt) to neutralize any methodological differences, thus avoiding measurement bias: the freezing of samples was carried out at -20ºC until the moment of the analysis. The COBAS v2.0 test was used as a reference since it is the most commonly used method. Quantitative analyzes were performed with results that were within the linear range in both methods (n=18). To make the methods comparable, the detection limit of the m2000rt assay for both (40 cp/mL or 1.60 log10 cp/mL) was adopted. The results below the limit of detection were presented as a categorical variable, since they are not quantifiable. The Pearson correlation coefficient was used to compare methods. The normality of the variables was then summarized calculating the estimated bias by the mean difference "đ" and standard deviation of the differences performed by t test for paired samples. Based on the lack of normality of the methods, the degree of agreement of the HIV viral load results was analyzed by the Kappa index. This study was approved by the Hospital de Clínicas of Porto Alegre (southern Brazil) Ethics Review Board, registered in the Brazil Platform as CAAE: 35072214.7.0000.532. Conclusion In conclusion, the m2000rt test that was modified for this trial showed good agreement and correlation with the most used test in this context and can be considered an alternative method with similar results to COBAS v2.0 and low costs in the HIV viral load quantification in cerebrospinal fluid. We suggest, especially in places where this method is readily available with an acceptable cost-benefit ratio, that the m2000rt exam should be performed.

Introdução A preocupação crescente com as possíveis consequências da replicação viral no sistema nervoso central mostra a necessidade da detecção do HIV no compartimento cerebral. O teste de PCR em tempo real desenvolvido pela Abbott, o Abbott m2000 RealTime HIV-1 (m2000rt), quantifica a carga viral do HIV em amostras de sangue com um procedimento efetivo e de baixo custo no nosso país, por isso é adotado como método padrão pelo Ministério da Saúde, mas não é utilizado em amostras de líquor. O ensaio produzido pela Roche, o COBAS TaqMan HIV-1, version 2 (COBAS v2.0), é o método de PCR em tempo real que tem sido amplamente utilizado para detectar a carga viral do HIV no compartimento cerebral. No entanto, esse método ainda não foi validado para esse propósito e seu custo pode ser uma limitação em diversas regiões com baixos recursos. Objetivos Considerando que não há uma metodologia padronizada para essa situação específica (detecção do HIV no líquor), nós conduzimos esse estudo a fim comparar os desempenhos dos testes m2000rt e COBAS v2.0, na tentativa de propôr um método alternativo e com baixos custos ao mais utilizado nesse contexto (COBAS v2.0). Métodos O estudo foi realizado no período de maio de 2015 a julho de 2016. O cálculo do tamanho da amostra foi baseado em dados de um estudo piloto que revelaram ser necessário um número mínimo de 37 amostras, para detectar uma diferença de 0,20 log10 na carga viral, com um coeficiente de correlação de 0,979 e um poder de 90%. Essa equação permitiria uma perda de 10%. As amostras de líquor foram coletadas consecutivamente a partir de 37 pacientes HIV positivos atendidos no Hospital de Clínicas de Porto Alegre/RS. Os métodos foram processados de acordo com o proposto pelo fabricante para utilização com amostras de plasma. Pequenas modificações foram necessárias no teste em estudo (m2000rt) para neutralizar qualquer diferença metodológica e evitar vieses de mensuração: o congelamento das amostras foi realizado a -20ºC até o momento da análise. O ensaio COBAS v2.0 foi utilizado como referência, uma vez que é o método mais utilizado. Foram realizadas análises quantitativas com resultados que estavam dentro da faixa linear em ambos os métodos (n = 18). Para tornar os métodos comparáveis, adotou-se o limite de detecção do ensaio m2000rt para ambos (40 cp/mL ou 1,60 log10 cp/mL). Os resultados abaixo do limite de detecção foram apresentados como uma variável categórica, uma vez que não são quantificáveis. O coeficiente de correlação de Pearson foi utilizado para comparar os métodos. A normalidade das variáveis foi então resumida calculando o viés estimado pela diferença média "đ " e o desvio padrão das diferenças realizadas pelo teste t para amostras pareadas. Com base na falta de normalidade dos métodos, o grau de concordância dos resultados das cargas virais de HIV foi analisado pelo índice Kappa. Esse estudo foi aprovado pelo comitê de ética do Hospital de Clínicas de Porto Alegre (RS)/ Brasil, registrado na Plataforma Brasil como sendo CAAE: 35072214.7.0000.532. Conclusão Em conclusão, o teste m2000rt que foi modificado para este ensaio mostrou boa concordância e correlação com o teste mais utilizado nesse contexto e pode ser considerado um método alternativo com resultados semelhantes ao COBAS v2.0 e baixos custos na quantificação da carga viral do HIV no líquor. Sugerimos, principalmente em locais onde este método está prontamente disponível com uma relação custo-benefício aceitável, que o exame m2000rt deva ser realizado. / Introduction Growing concern about possible consequences of viral replication in the central nervous system shows the need for HIV detection in the cerebral compartment. The real time PCR test developed by Abbott, Abbott RealTime m2000 HIV-1 (m2000rt) quantifies HIV viral load in blood samples effectively and with low costs Brazil. It is the standard method by the Brazilian Ministry of Health, but it has never been utilized to measure HIV in cerebrospinal fluid samples. The assay produced by Roche, COBAS TaqMan HIV-1, version 2 (COBAS v2.0) is the real-time PCR method that has been widely used to detect HIV viral load in cerebral compartment. However, this method has not yet been validated for this purpose and its cost may be a limitation in several regions in the world with low resources. Objective Taking under consideration that there was no standard methodology for this specific situation (detecting HIV in cerebrospinal fluid), we conducted this study to compare the performances of the m2000rt and COBAS v2.0 assays, to propose an alternative and low-cost method to more used in this context (COBAS v2.0). Methods The study was conducted from May 2015 to July 2016. The sample size calculation was based on data from a pilot trial that revealed that a minimum of 37 samples would be needed to detect a difference of 0.20 log10 in viral load, with a correlation coefficient of 0.979 and a 90% power. This equation would allow a 10% lost. CSF samples were collected consecutively from 37 HIV-positive patients seen at Hospital de Clínicas, Porto Alegre, RS. Methods were processed according to proposed by the manufacturer for utilization with plasma samples. Small modifications were necessary in the study test (m2000rt) to neutralize any methodological differences, thus avoiding measurement bias: the freezing of samples was carried out at -20ºC until the moment of the analysis. The COBAS v2.0 test was used as a reference since it is the most commonly used method. Quantitative analyzes were performed with results that were within the linear range in both methods (n=18). To make the methods comparable, the detection limit of the m2000rt assay for both (40 cp/mL or 1.60 log10 cp/mL) was adopted. The results below the limit of detection were presented as a categorical variable, since they are not quantifiable. The Pearson correlation coefficient was used to compare methods. The normality of the variables was then summarized calculating the estimated bias by the mean difference "đ" and standard deviation of the differences performed by t test for paired samples. Based on the lack of normality of the methods, the degree of agreement of the HIV viral load results was analyzed by the Kappa index. This study was approved by the Hospital de Clínicas of Porto Alegre (southern Brazil) Ethics Review Board, registered in the Brazil Platform as CAAE: 35072214.7.0000.532. Conclusion In conclusion, the m2000rt test that was modified for this trial showed good agreement and correlation with the most used test in this context and can be considered an alternative method with similar results to COBAS v2.0 and low costs in the HIV viral load quantification in cerebrospinal fluid. We suggest, especially in places where this method is readily available with an acceptable cost-benefit ratio, that the m2000rt exam should be performed.

Introdução A preocupação crescente com as possíveis consequências da replicação viral no sistema nervoso central mostra a necessidade da detecção do HIV no compartimento cerebral. O teste de PCR em tempo real desenvolvido pela Abbott, o Abbott m2000 RealTime HIV-1 (m2000rt), quantifica a carga viral do HIV em amostras de sangue com um procedimento efetivo e de baixo custo no nosso país, por isso é adotado como método padrão pelo Ministério da Saúde, mas não é utilizado em amostras de líquor. O ensaio produzido pela Roche, o COBAS TaqMan HIV-1, version 2 (COBAS v2.0), é o método de PCR em tempo real que tem sido amplamente utilizado para detectar a carga viral do HIV no compartimento cerebral. No entanto, esse método ainda não foi validado para esse propósito e seu custo pode ser uma limitação em diversas regiões com baixos recursos. Objetivos Considerando que não há uma metodologia padronizada para essa situação específica (detecção do HIV no líquor), nós conduzimos esse estudo a fim comparar os desempenhos dos testes m2000rt e COBAS v2.0, na tentativa de propôr um método alternativo e com baixos custos ao mais utilizado nesse contexto (COBAS v2.0). Métodos O estudo foi realizado no período de maio de 2015 a julho de 2016. O cálculo do tamanho da amostra foi baseado em dados de um estudo piloto que revelaram ser necessário um número mínimo de 37 amostras, para detectar uma diferença de 0,20 log10 na carga viral, com um coeficiente de correlação de 0,979 e um poder de 90%. Essa equação permitiria uma perda de 10%. As amostras de líquor foram coletadas consecutivamente a partir de 37 pacientes HIV positivos atendidos no Hospital de Clínicas de Porto Alegre/RS. Os métodos foram processados de acordo com o proposto pelo fabricante para utilização com amostras de plasma. Pequenas modificações foram necessárias no teste em estudo (m2000rt) para neutralizar qualquer diferença metodológica e evitar vieses de mensuração: o congelamento das amostras foi realizado a -20ºC até o momento da análise. O ensaio COBAS v2.0 foi utilizado como referência, uma vez que é o método mais utilizado. Foram realizadas análises quantitativas com resultados que estavam dentro da faixa linear em ambos os métodos (n = 18). Para tornar os métodos comparáveis, adotou-se o limite de detecção do ensaio m2000rt para ambos (40 cp/mL ou 1,60 log10 cp/mL). Os resultados abaixo do limite de detecção foram apresentados como uma variável categórica, uma vez que não são quantificáveis. O coeficiente de correlação de Pearson foi utilizado para comparar os métodos. A normalidade das variáveis foi então resumida calculando o viés estimado pela diferença média "đ " e o desvio padrão das diferenças realizadas pelo teste t para amostras pareadas. Com base na falta de normalidade dos métodos, o grau de concordância dos resultados das cargas virais de HIV foi analisado pelo índice Kappa. Esse estudo foi aprovado pelo comitê de ética do Hospital de Clínicas de Porto Alegre (RS)/ Brasil, registrado na Plataforma Brasil como sendo CAAE: 35072214.7.0000.532. Conclusão Em conclusão, o teste m2000rt que foi modificado para este ensaio mostrou boa concordância e correlação com o teste mais utilizado nesse contexto e pode ser considerado um método alternativo com resultados semelhantes ao COBAS v2.0 e baixos custos na quantificação da carga viral do HIV no líquor. Sugerimos, principalmente em locais onde este método está prontamente disponível com uma relação custo-benefício aceitável, que o exame m2000rt deva ser realizado. / Introduction Growing concern about possible consequences of viral replication in the central nervous system shows the need for HIV detection in the cerebral compartment. The real time PCR test developed by Abbott, Abbott RealTime m2000 HIV-1 (m2000rt) quantifies HIV viral load in blood samples effectively and with low costs Brazil. It is the standard method by the Brazilian Ministry of Health, but it has never been utilized to measure HIV in cerebrospinal fluid samples. The assay produced by Roche, COBAS TaqMan HIV-1, version 2 (COBAS v2.0) is the real-time PCR method that has been widely used to detect HIV viral load in cerebral compartment. However, this method has not yet been validated for this purpose and its cost may be a limitation in several regions in the world with low resources. Objective Taking under consideration that there was no standard methodology for this specific situation (detecting HIV in cerebrospinal fluid), we conducted this study to compare the performances of the m2000rt and COBAS v2.0 assays, to propose an alternative and low-cost method to more used in this context (COBAS v2.0). Methods The study was conducted from May 2015 to July 2016. The sample size calculation was based on data from a pilot trial that revealed that a minimum of 37 samples would be needed to detect a difference of 0.20 log10 in viral load, with a correlation coefficient of 0.979 and a 90% power. This equation would allow a 10% lost. CSF samples were collected consecutively from 37 HIV-positive patients seen at Hospital de Clínicas, Porto Alegre, RS. Methods were processed according to proposed by the manufacturer for utilization with plasma samples. Small modifications were necessary in the study test (m2000rt) to neutralize any methodological differences, thus avoiding measurement bias: the freezing of samples was carried out at -20ºC until the moment of the analysis. The COBAS v2.0 test was used as a reference since it is the most commonly used method. Quantitative analyzes were performed with results that were within the linear range in both methods (n=18). To make the methods comparable, the detection limit of the m2000rt assay for both (40 cp/mL or 1.60 log10 cp/mL) was adopted. The results below the limit of detection were presented as a categorical variable, since they are not quantifiable. The Pearson correlation coefficient was used to compare methods. The normality of the variables was then summarized calculating the estimated bias by the mean difference "đ" and standard deviation of the differences performed by t test for paired samples. Based on the lack of normality of the methods, the degree of agreement of the HIV viral load results was analyzed by the Kappa index. This study was approved by the Hospital de Clínicas of Porto Alegre (southern Brazil) Ethics Review Board, registered in the Brazil Platform as CAAE: 35072214.7.0000.532. Conclusion In conclusion, the m2000rt test that was modified for this trial showed good agreement and correlation with the most used test in this context and can be considered an alternative method with similar results to COBAS v2.0 and low costs in the HIV viral load quantification in cerebrospinal fluid. We suggest, especially in places where this method is readily available with an acceptable cost-benefit ratio, that the m2000rt exam should be performed.