Relation between stage of disease and neurobehavioral measures in children with symptomatic HIV disease.
OBJECTIVE
To study the relationships between stage of HIV disease, reflected by CD4+ lymphocyte percentages and p24 antigen levels, and HIV-associated central nervous system (CNS) abnormalities, measured by computed tomography (CT) brain-scan ratings and neurobehavioral tests.


METHODS
Consecutive case series.


METHODS
Government medical research center.


METHODS
Eighty-six previously untreated children with symptomatic HIV-1 disease.


RESULTS
CD4% measures correlated significantly with overall CT brain-scan severity ratings (r = -0.45; P < 0.001) as well as with its component parts (cortical atrophy, white matter abnormalities, and intracerebral calcifications); they were of comparable magnitude for vertically and transfusion-infected children. CD4% measures were also associated with the general level of cognitive function (r = 0.32; P < 0.005). Furthermore, patients with detectable serum p24 antigen levels (n = 39) had CT brain scans that were more abnormal than patients with undetectable p24 levels (n = 20; CT abnormality ratings of 21.3 versus 35.9; P < 0.02); similar differences were found for the cortical atrophy and calcification ratings. p24 levels also correlated with the overall CT brain-scan severity rating (r = 0.34; P < 0.01).


CONCLUSIONS
Degree of CT brain-scan abnormality and level of cognitive dysfunction were significantly associated with the stage of HIV-1 disease, as reflected by either CD4 leukocyte measures or elevations of p24 antigen. The relation between the CT brain-scan lesions and markers of HIV disease (both CD4 and p24) suggest that these CNS abnormalities are most likely associated with HIV-1 infection, and further support the hypothesis that the interaction between systemic disease progression and CNS manifestations is continuous rather than discrete.
Brouwers
P
P
Pediatric Branch, National Cancer Institute, NIH Clinical Center, Bethesda, MD 20892-1928, USA.
Tudor-Williams
G
G
DeCarli
C
C
Moss
H A
HA
Wolters
P L
PL
Civitello
L A
LA
Pizzo
P A
PA
D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D016655:HIV Core Protein p24 / Q000032:analysis; D015497:HIV-1; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D014057:Tomography, X-Ray Computed
D016655:HIV Core Protein p24