Risk of human immunodeficiency virus type 1-related neurologic disease in a cohort of intravenous drug users.
BACKGROUND
Although the proportion of cases of acquired immunodeficiency syndrome related to intravenous drug use has increased dramatically over the past decade, there has been no longitudinal examination of primary neurologic disease in this group.


OBJECTIVE
To study the development of neurologic disease in human immunodeficiency virus (HIV)-negative and HIV-positive men and women who were intravenous drug users over a 3.5-year period.


METHODS
Prospective observational cohort study.


METHODS
Subjects were recruited from an infectious disease clinic at a New York City Hospital or from a methadone maintenance program.


METHODS
Ninety-nine HIV-negative (62 men and 37 women) and 124 HIV-positive (85 men and 39 women) intravenous drug users volunteered.


METHODS
The development of clinically significant manifestations in six neurologic domains.


RESULTS
With multivariate adjustment for current and past substance abuse, age, education, and head injury, we examined the odds of developing HIV-related neurologic disease. Extrapyramidal signs and reduced motor ability became increasingly apparent over time in HIV-infected men as their CD4 cell count declined and as the subjects developed the acquired immunodeficiency syndrome. Fewer neurologic signs were seen in the women.


CONCLUSIONS
The impact of HIV infection among intravenous drug users parallels that in homosexual men and is independent of alcohol and other drug use.
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015819:Substance Abuse, Intravenous