Methods for detecting early signs of AIDS dementia complex in asymptomatic HIV-1-infected subjects.
OBJECTIVE
To determine the optimal diagnostic procedures for identifying early signs of AIDS dementia complex (ADC) in asymptomatic HIV-1-infected individuals, in order to prevent further cognitive function impairment by early treatment.


METHODS
Study patients had been referred electively and consecutively to hospital; all had been referred for the first time and gave informed consent. Inclusion criteria were (1) lack of history and/or symptoms of psychosis and neurological disorders; (2) lack of active viral, protozoan or fungal pathology; (3) abstinence from heroin and/or cocaine for at least 6 months before baseline evaluation.


METHODS
Subjects were seen at the L. Spallanzani Hospital for Infectious Diseases, Rome, Italy between March 1989 and March 1991.


METHODS
Eighty-two asymptomatic HIV-1-infected subjects: 41 drug users, 27 homosexuals and 14 heterosexuals.


METHODS
All subjects were evaluated using Wechsler-Bellevue I, Benton C form and Bender tests. Thirty-nine subjects underwent single-photon emission computed tomography (SPECT) and 12 magnetic resonance imaging (MRI). The immunological status of each subject was determined.


RESULTS
On psychometric testing, 23 out of the 82 (28%) asymptomatic subjects had a mental decay percentage (MD%) > or = 20%. Cerebral perfusion abnormalities were detected in 31 out of 39 (79.48%) subjects who underwent SPECT; MRI abnormalities were observed in seven out of 12 (58%) subjects. Twelve out of 23 subjects with MD% > or = 20, 15 out of 29 subjects with SPECT abnormalities and four out of seven patients with MRI abnormalities had total CD4+ lymphocyte counts > or = 500 x 10(6)/l.


CONCLUSIONS
The high incidence of abnormal SPECT and of MD% > or = 20 in asymptomatic HIV-1-infected patients, and the lack of correlation between immunological status and degree of mental decay, SPECT and MRI abnormalities raise many questions about subclinical HIV-1 neurological disease.
L. Spallanzani Hospital for Infectious Diseases, Rome, Italy.
M A
MA
Rosci
F
F
Pigorini
A
A
Bernabei
F M
FM
Pau
V
V
Volpini
D E
DE
Merigliano
M F
MF
Meligrana
D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000276:immunology / Q000523:psychology; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D015497:HIV-1; D006801:Humans; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015899:Tomography, Emission-Computed, Single-Photon