Cerebrospinal fluid cytokines, matrix metalloproteinases, HIV, and tuberculous meningitis.

Sir,

Raj et al. reported on “cerebrospinal fluid cytokines, matrix metalloproteinases, HIV and tuberculous meningitis.[1]” Raj et al. noted that “HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis (TBM) except for IL-1β level.[1]” In fact, many reports show that HIV infection results in alteration of CSFcytokine[2] and matrix metalloproteinases.[3] Juan et al. reported that “CSF INF-gamma levels (>6.4 IU/mL) are very valuable in TBM diagnosis.[4]” The question is why the observation by Raj et al. is different. First, the confounding medical disorders, including to the opportunistic infection, should be well considered. For example, the Cryptococcal meningitis can affect the CSF cytokine,[56] and cytokine therapy is also an alternative treatment for the Cryptococcal meningitis.[7] A further study with control of confounding medical disorder and treatment in HIV-infected cases is suggested.