Relationship of beta 2 microglobulin and CD4 counts to neuropsychological performance in HIV-1-infected intravenous drug users.
This study explores the relationship of immune dysfunction to the neuropsychological performance of i.v. drug users (IVDUs) infected with HIV-1. Ninety-seven HIV-positive and 45 HIV-negative former IVDUs on methadone maintenance were evaluated using neuropsychological measures, physical examinations, and measures of immune function, including absolute CD4 counts and beta 2 microglobulin (beta 2-M). There were no significant differences between the HIV-positive and HIV-negative subjects on any single neuropsychological domain. There was, however, a significant group difference on a composite indicator of neuropsychological impairment, with 32% of HIV-positive subjects demonstrating some degree of overall impairment compared with only 13% of HIV-negative subjects. HIV-positive subjects were then stratified according to the Centers for Disease Control (CDC) symptom groupings: group II, asymptomatic, n = 29; group III, lymphadenopathy, n = 30; and group IV A or C-2, symptomatic, non-AIDS, n = 38. There were no significant neuropsychological differences among the three CDC groups. The HIV-positive subjects were also stratified on absolute CD4 counts (< or = 200, 201-400, and > 400) and beta 2-M (> or = 5, 3-5, and < 3). Individuals with greater immune compromise (CD4, < 200, beta 2-M, > or = 5) were more impaired on measures of motor functioning. beta 2-M was found to be a better predictor than CD4 count of impaired neuropsychological performance. Furthermore, individuals with beta 2-M values > or = 5 have more than a threefold increase in the incidence of neuropsychological impairment than those with beta 2-M values < 3.0. These results suggest that beta 2-M may serve as a useful clinical marker for the development of neuropsychological impairment and that the risk of such impairment increases as the immune system weakens.
Boccellari
A A
AA
Department of Psychiatry, San Francisco General Hospital, CA 94110.
Chambers
D B
DB
Dilley
J W
JW
Shore
M D
MD
Tauber
M A
MA
Moss
A R
AR
Osmond
D H
DH
D000328:Adult; D000704:Analysis of Variance; D015496:CD4-Positive T-Lymphocytes; D003072:Cognition Disorders / Q000209:etiology* / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000523:psychology*; D018023:HIV Seronegativity; D015497:HIV-1; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009483:Neuropsychological Tests; D010808:Physical Examination; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D001613:beta 2-Microglobulin / Q000032:analysis*
D001613:beta 2-Microglobulin; D008691:Methadone