A prospective comparison of neuropsychologic function in HIV-seropositive and seronegative methadone-maintained patients

Comparison of Neuropsychological Performance between AIDS-Free Injecting Drug Users and Homosexual Men

“…Again, studies with larger sample sizes and prospective cohorts with strict control for age and education found no substantial differences in the cognitive perfor mance of HIV-infected and noninfected indi viduals [10,14], In those large studies where some statistically significant difference of worse performance in few cognitive tests among AIDS-free HIV-infected individuals was seen, these changes in raw scores are very small and have no apparent clinical impact on day-to-day functioning [12,29], Although a concern in the generalization of the results of the effect of HIV infection on neuropsychologic performance has been the argument that less favored populations, i.e. populations with less education, inadequate health care and malnutrition, might be more prone to early HIV cognitive effects, our results do not sup port this argument [13,[17][18][19], Additionally, our results suggest that ad justment of neuropsychologic performance by IQ scores may be a better correction for premorbid differences than years of education. One cross-sectional study, where full IQ scores of the Revised Wechsler Adult Intelli gence Scale and educational levels among asymptomatic HIV-infected and noninfected individuals were comparable, showed no dif ferences in the neuropsychologic performance between both groups [5], Riccio et al [28] had similar results at baseline and 12-month fol low-up among asymptomatic HIV-infected and noninfected individuals matched on sim ilar educational and National Adult Reading test IQ levels.…”

“…Con sistently, prospective studies and most crosssectional studies with strict adjustment for age and education have revealed no signifi cant differences between the neuropsychologic performance among AIDS-free HIVinfected and noninfected individuals [5,6,8,11,13,28]. Similar arguments and conclu sions apply with regard to the cognitive per formance among AIDS-free HIV-infected and noninfected individuals of minority groups [10,14,[16][17][18][19]29]. Again, studies with larger sample sizes and prospective cohorts with strict control for age and education found no substantial differences in the cognitive perfor mance of HIV-infected and noninfected indi viduals [10,14], In those large studies where some statistically significant difference of worse performance in few cognitive tests among AIDS-free HIV-infected individuals was seen, these changes in raw scores are very small and have no apparent clinical impact on day-to-day functioning [12,29], Although a concern in the generalization of the results of the effect of HIV infection on neuropsychologic performance has been the argument that less favored populations, i.e.…”

“…ethnicity and substance abuse, had no significant effect in most neuropsychologic test scores. Ethnicity or minority status has been associated with poor performance in some neurocognitive studies [14,17,31]. This analysis was not aimed at evaluating the in trinsic effect of a person's race in the neuro psychologic performance but rather control ling for ethnicity as a marker of minority group, an indicator for social and environ mental disadvantage and its effect on neuro cognition among others [32], As expected, no significant effect of CD4 levels was observed since the participants in this analysis were in relatively early stages of HIV infection.…”

“…Several studies have assessed whether or not clinically significant cognitive impairment is present in otherwise healthy HIV-infected individuals, but results have been contradictory [2][3][4], Nevertheless, there is agreement among larger well-con trolled cohort and longitudinal follow-up studies of no significant increase in cognitive impairment during asymptomatic HIV infec tion [6,[8][9][10][13][14][15], The study populations in the majority of the above studies consist predominantly of white, well-educated, homosexual volunteers. However, considerable attention has been de voted to less educated and minority groups, mostly injecting drug users [10,[16][17][18][19]. It is well documented that factors such as age, edu cation and premorbid intellectual level affect performance in neuropsychologic tests [20][21][22].…”

HIV-1 associated cognitive/motor complex in an injecting drug user

“…Comparable studies of the ADC/HACC using cohorts of HIV positive drug users have only recently been started (McKeganney et al, 1990). Drug users are often unreliable, and this makes studies of their cognitive function difficult.…”