Evidence of CNS impairment in HIV infection: clinical, neuropsychological, EEG, and MRI/MRS study.
OBJECTIVE
To identify by clinical examination, EEG, MRI, and proton spectroscopy, and neuropsychological assessment the prevalence of signs of CNS involvement in patients infected with HIV, and to relate such findings to the evidence of immunosuppression.


METHODS
The design was a cross sectional analysis of a cohort of male patients with infected HIV with an AIDS defining diagnosis or low CD4 count (<350), and seropositive asymptomatic subjects, both groups being followed up in a longitudinal study. Control groups consisted of seronegative subjects from the same genitourinary medicine clinics.


RESULTS
This report sets out the cross sectional findings at the seventh visit in the longitudinal study. Patients with AIDS had more signs of neurological dysfunction, poorer performance on a neuropsychological test battery, were more likely to have an abnormal EEG, and to have abnormalities on MRI. They more often had cerebral atrophy, abnormal appearing white matter, and abnormal relaxometry and spectroscopy. There was little evidence of abnormality in seropositive people who had a CD4 count >350 compared with seronegative people from a similar background.


CONCLUSIONS
Detailed testing failed to disclose significant CNS impairment without immunosuppression in men infected with HIV. Findings from MRI and magnetic resonance spectroscopy (MRS) correlated with those of the neurological examination and neuropsychological assessment. A combination of such assessments offers a simple surrogate for studies of CNS involvement in HIV disease.
Harrison
M J
MJ
Department of Neurology and Clinical Neurophysiology, University College London Hospital and Medical School, UK.
Newman
S P
SP
Hall-Craggs
M A
MA
Fowler
C J
CJ
Miller
R
R
Kendall
B E
BE
Paley
M
M
Wilkinson
I
I
Sweeney
B
B
Lunn
S
S
Carter
S
S
Williams
I
I
D015526:AIDS Dementia Complex / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001284:Atrophy; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D018791:CD4 Lymphocyte Count; D002794:Choline / Q000378:metabolism; D015331:Cohort Studies; D003401:Creatine / Q000378:metabolism; D003430:Cross-Sectional Studies; D004569:Electroencephalography; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests
D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline