The Edinburgh cohort of HIV-positive injecting drug users at 10 years after infection: a case-control study of the evolution of dementia.
OBJECTIVE
To examine the evolution of dementia in HIV-positive injecting drug users (IDU) in Edinburgh.


METHODS
Case-control study.


METHODS
Twenty six (6%) out of 404 patients in the Edinburgh cohort of HIV-positive IDU who have developed HIV-1-associated dementia in the 10 years since infection and seroconversion.


METHODS
Patients were tested repeatedly, where possible, on a range of neuropsychological and neurophysiological measures. The results from patients with dementia were compared with those of age, sex and IQ-matched non-demented HIV-positive controls from the cohort. An auditory event-related potential (P3 or P300), a neurophysiological measure of cognitive function, detected the onset of a marked slowing of cognitive and psychomotor functions. Neuropsychological measures that involve the speed of information processing such as the Trail-Making task also identified the early stages of dementia.


RESULTS
Dementia was associated with a more advanced stage of systemic disease, increased rates of decline in CD4 cell counts and markedly reduced survival compared with the non-demented controls. No evidence for a protective effect of treatment with zidovudine was detected.


CONCLUSIONS
In the first 10 years after infection with HIV-1 dementia is an individual development, not the clinical extreme of general intellectual impairment, and had occurred in at least 6% of our IDU cohort. Future questions concern the long-term rate of dementia, the critical neuropathological change and the true potential for early treatment.
Goodwin
G M
GM
University Department of Psychiatry, Royal Edinburgh Hospital, UK.
Pretsell
D O
DO
Chiswick
A
A
Egan
V
V
Brettle
R P
RP
D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology* / Q000523:psychology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003071:Cognition; D018450:Disease Progression; D005072:Evoked Potentials, Auditory; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D015819:Substance Abuse, Intravenous; D006113:United Kingdom / Q000453:epidemiology; D015215:Zidovudine / Q000627:therapeutic use
D000998:Antiviral Agents; D015215:Zidovudine