Neurological and neuropsychological performance in HIV seropositive men without symptoms.

Abstract

with AIDS,4 though pathological studies show an even higher prevalence of a subacute encephalitis,5 which is believed to be due to HIV itself.6 Five to 10% of subjects also develop signs of damage to the peripheral nervous system,7 and at postmortem as many as 25% show signs of spinal cord disease.8 Controversy exists over the possibility that asymptomatic seropositive individuals might show subclinical evidence of evolving damage to either the central or peripheral nervous system. In particular it has been suggested that such individuals show impaired performance when subjected to a battery of neuropsychological tests.9 At the end of 1987 we therefore embarked upon a longitudinal study ofa cohort of seropositive and seronegative homosexual men, who underwent neurological, neurophysiological, and neuropsychological tests at six to nine month intervals. Annual recording of event related evoked potentials (P300s), central motor conduction times with magnetic stimulation, anid magnetic resonance imaging of the brain (MRI scanning) were added to the assessments at the second visit. This report of the cross sectional comparison of seropositive and seronegative subjects combines the clinical, neuropsychological, and neurophysiological data from the first visit and the MRI, magnetic stimulation, and P300 data collected for the first time at the second visit.

The motor evoked potential in aids and HAM/TSP State of the evidence

“…The third study reporting abnormalities was done by Parisi et al 32 , who found up to 20% CMCT abnormalities; however the scarcity of data published did not allow for a more detailed analysis. These studies contrasted with others 24,27,42,43 that did not find CMCT abnormalities in neurologically asymptomatic and symptomatic patients despite up to three years of follow up with some patients [42]. On the other hand, Moglia et al 25 , applied HIVES to 87 patients who had mixed clinical CDC stages and also found a prolongation of CMCT.…”

“…Therefore, we consider that the aforementioned factors, cofactors and stressors, among others 2,58,61,62,65 could co-vary with endogenous or exogenous retroviruses modifying AIDS and HAM/TSP clinical course 69,76 as well as TMS measures 25,42 in still unknown and untested forms. And they may account for some or all of the uneven results discussed above.…”

Auditory brainstem responses in a Rhesus Macaque model of neuro-AIDS

“…This constellation of symptoms is a common feature of AIDS and has been referred to as AIDS related dementia. The existence of early cognitive and motor de®cits associated with the asymptomatic phase of HIV infection is now also clear, although these de®cits may be quite subtle (Borstein et al, 1992;Sinforiani et al, 1991;Clifford et al, 1990;McAllister et al, 1992;Perry et al, 1989;Riedel et al, 1992;Arendt et al, 1990;Martin et al, 1991Martin et al, , 1992aKarlsen et al, 1992a, b). Upon post mortem examination, estimates of the number of AIDS patients with CNS lesions range as high as 80% (Elder et al, 1988).…”

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

“…Even though, in some studies, age and education among HIV-seropositive and -seronegative individuals showed no statisti cally significant difference in the univariate analysis, trends of lower mean education in HIV-infected individuals or advanced stages of HIV infection are observed [2], This trend however acquires major relevance consid ering the small sample sizes of these studies. Few cross-sectional studies have strictly and adequately controlled for both age and educa tion among other confounders [5,6,11). 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].…”