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a Department of
Neurology and Clinical Neurophysiology, b Department of Health Psychology, c Department of Radiology, d Department
of Sexually Transmitted Diseases, University College London Hospital
and Medical School, London, UK
Correspondence to: Professor MJG Harrison, The Middlesex Hospital, Mortimer Street, London, W1N 8AA, UK.
Received 16 April 1997 and in revised form 20 January 1998;
Accepted 17 February 1998
OBJECTIVES
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.
METHODSThe 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.
RESULTSThis 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.
CONCLUSIONSDetailed
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 neuropsychogical assessment. A combination
of such assessments offers a simple surrogate for studies of CNS
involvement in HIV disease.
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