A Prospective Longitudinal Study of Neuropsychological and Psychosocial Factors in Asymptomatic Individuals at Risk for Htlv-III/Lav Infection in a Methadone Program: Preliminary Findings

Abstract

To test the hypothesis that cognitive impairment may be present early in the course of HTLV-III/LAV infection, intravenous drug abusers (IDVAs) without overt symptoms of AIDS related illness were tested with standard neuropsychological and psychosocial measures. This study is the baseline for a prospective longitudinal study of the natural history of HTLV-III/LAV infection in this high risk population. Of 211 subjects initially evaluated, 70 (33%) were HTLV-III/LAV seropositive and 141 (67%) were seronegative. At the baseline, by univariate analysis, the seropositive IVDAs were significantly (p less than .05) more impaired than seronegatives on 4 of 8 measures: Finger Tapping--dominant, hand, Digit Span Forward, Trail making A and WAIS-Similarities. However, by multivariate analysis the seropositives were significantly more impaired only on the WAIS-Similarities and Wechsler--Associative Learning tests. Multiple factors such as drug use and psychological stress may have influenced test performance. These preliminary results, however, suggest that seropositive IVDAs may show evidence of impaired neuropsychological function even in the absence of AIDS related symptoms and are consistent with the hypothesis of the early neurotropism of HTLV-III/LAV.

Simple and choice reaction time in patients with human immunodeficiency virus infection

“…Impaired cognitive performance has been observed in patients with AIDS and AIDS-related complex (ARC) 12 1-231. Although evidence of cognitive dysfunction has been found in asymptomatic HIV antibody-seropositive (HIVAb +) homosexual men [211 and intravenous drug users [24] and in patients with persistent generalized lymphadenopathy [2 51, other studies indicate that asymptomatic HIV-Ab + homosexual men do not demonstrate cognitive abnormalities 122, 231 and that even patients with AIDS may not show appreciable signs of dementia 1261.…”

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

“…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.…”

“…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].…”

Cognitive behavior in asymptomatic (CDC stage II and III) HIV — seropositive intravenous drug users (IVDUs)

“…It has often been stressed that these results cannot be extrapolated to other HIV-infected persons such as intravenous drug users [10]. Few studies, indeed, have concentrated on IVDUs [2,11,27] because these patients represent a heterogeneous group as regards education and exposure to drugs that affect the CNS (alcohol, opioids, etc. ); however, they are by far the largest group of HIV-positive subjects in Italy.…”

“…Neuropsychological changes have been described in patients with AIDS or AIDS-related complex (ARC) [6,10,12,18,23,24,28], in patients in the persistent generalized lymphadenopathy stage (PGL) [9,25], and in HIV-positive, asymptomatic homosexuals and intravenous heroin addicts [6,18,27,29].…”