Neurologic signs and symptoms in a cohort of homosexual men followed for 4.5 years.
We traced the development of neurologic impairment in 207 homosexual men (123 human immunodeficiency virus [HIV]-positive and 84 HIV-negative controls) over 4.5 years of follow-up. We applied generalized estimating equations to logistic regression analyses with repeated measures to examine the differences between HIV-positive and HIV-negative subjects with respect to the likelihood of developing six neurologic outcomes derived from a factor analysis, significant neurologic impairment (modified Kurtzke disability score of > or = 3), or significant neuropsychological impairment. We found that, over time, HIV-positive subjects were more likely to develop clinically significant extrapyramidal signs and frontal release signs than HIV-negative subjects. Controlling for age or education, as CD4 count declined, the odds of developing significant extrapyramidal signs, abnormalities in alternating movements, frontal release signs, and a Kurtzke score > or = 3 increased. HIV-positive subjects were almost five times as likely (odds ratio [OR], 4.6; 95% CI, 1.6 to 13.4) as HIV-negative subjects to stay the same or worsen neurologically on the next visit, and those with CD4 < or = 200 were 4.8 times as likely (OR, 4.8; 95% CI, 2.2 to 10.7) to maintain or worsen neurologically relative to those with higher CD4 counts. We conclude that neurologic impairment becomes increasingly apparent over time in HIV-infected men, especially in those with low CD4 counts.
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.
K
K
Marder
X
X
Liu
Y
Y
Stern
G
G
Dooneief
K
K
Bell
P
P
Schofield
N
N
Sacktor
G
G
Todak
R
R
Friedman
A
A
Ehrhardt
D000328:Adult; D015331:Cohort Studies; D018023:HIV Seronegativity / Q000502:physiology*; D006679:HIV Seropositivity / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D018451:Homosexuality, Male; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D016017:Odds Ratio; D013997:Time Factors