Brain HMPAO-SPECT and ocular microangiopathic syndrome in HIV-1-infected patients.
OBJECTIVE
The pathogenesis of neurologic and neuropsychologic dysfunction in HIV-1 infection is unclear. The purpose of the study was to determine an association between cerebral perfusion and HIV-1-related ocular microangiopathic syndrome.


METHODS
We studied 28 HIV-1-infected patients, seven of whom presented with asymptomatic HIV infection, nine with lymphadenopathy syndrome or AIDS-related complex, and 12 with AIDS. Cerebral perfusion was semi-quantitatively measured by single photon emission computed tomography of the brain using technetium-99 hexamethyl-propylenamine oxime (HMPAO-SPECT). The conjunctival manifestation of HIV-1-related microangiopathic syndrome was measured by a rating scale determining blood-flow sludging and, retinal cotton-wool spots were counted. CD4 count, neopterin, beta 2-microglobulin (beta 2M), haemoglobin, and age were determined as putative confounding variables.


RESULTS
Mean conjunctival sludge in patients with normal HMPAO-SPECT findings was 1.3 +/- 0.5 (mean +/- s.e.m.); no cotton-wool spots were present. In patients with slightly impaired HMPAO-SPECT, it was 2.1 +/- 0.6 and mean cotton-wool spot count was 1.1 +/- 0.4. In patients with severely impaired HMPAO-SPECT, mean conjunctival sludge was 4.5 +/- 0.3 and mean cotton-wool spot count was 4.9 +/- 1.1 HMPAO-SPECT findings were closely associated with conjunctival sludge (r = 0.72; P < 0.001) and number of cotton-wool spots (r = 0.78; P < 0.001), whereas only a slight association with staging of HIV disease was found (P = 0.052). Analysis of covariance controlling for CD4 count neopterin, beta 2M, age, and haemoglobin demonstrated a significant difference between the three HMPAO-SPECT groups for both the number of cotton-wool spots (P < 0.001) and the conjunctival sludge rating (P < 0.001).


CONCLUSIONS
There was a close association between severity of HIV-1-related ocular microangiopathic syndrome and severity of cerebral hypoperfusion. Microvascular alterations might contribute to the pathogenesis of neurological and neuropsychological symptoms in patients with HIV-1 disease. Furthermore, the conjunctival sludge rating and the number of cotton-wool spots might be appropriate indicators for severity of microvascular changes of the central nervous system [corrected].
Geier
S A
SA
Medizinische Poliklinik, Ludwig-Maximilians-Universität München, Germany.
Schielke
E
E
Tatsch
K
K
Sadri
I
I
Bogner
J R
JR
Hammel
G
G
Einhäupl
K M
KM
Goebel
F D
FD
D000386:AIDS-Related Complex / Q000150:complications / Q000000981:diagnostic imaging; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D001708:Biopterins / Q000031:analogs & derivatives / Q000097:blood; D001921:Brain / Q000000981:diagnostic imaging*; D015496:CD4-Positive T-Lymphocytes; D003228:Conjunctiva / Q000098:blood supply*; D003229:Conjunctival Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging*; D015497:HIV-1; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D019798:Neopterin; D015609:Organotechnetium Compounds; D010091:Oximes; D013577:Syndrome; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D001613:beta 2-Microglobulin / Q000032:analysis
D006454:Hemoglobins; D015609:Organotechnetium Compounds; D010091:Oximes; D001613:beta 2-Microglobulin; D001708:Biopterins; D019690:Technetium Tc 99m Exametazime; D019798:Neopterin