Neurological Symptoms, Not Signs, Are Common in Early HIV Infection

Abstract

One hundred-nine controls and 386 HIV-infected volunteers enrolled in the HIV Neurobehavioral Research Center (HNRC) longitudinal study. The majority, without acquired immune deficiency syndrome (AIDS), were screened for alcohol/substance abuse; previous diagnosis of HIV-associated dementia; and HIV-unrelated developmental, neurological, medical, and neurobehavioral conditions which potentially impair cognition; and underwent a structured neurological interview and examination, standardized NP testing, and psychiatric interview as part of a more extensive battery. A large subset (N = 377) underwent lumbar puncture for cerebrospinal fluid (CFS) examination. We examined the relationship of sixteen select but independent variables, using stepwise multiple regressions, from demographic/staging, immunological, NP, and psychiatric domains to neurological symptoms in an effort to identify possible predictors of subclinical nervous systems involvement. Results. All categories of neurological symptoms were significantly more prevalent among medically asymptomatic (CDC stage A) subjects than controls, with a further rise in prevalence in those with more advanced stages of infection. The most marked rise was seen in cognitive and sensorimotor complaints. In contrast, significant findings on neurological examination were evident in only the sicker (stage C) subjects. Stage of illness, serum β2-microglobulin, psychiatric indices of depressed mood or anxiety, and NP "motor" performance were the most significant independent variables associated with the presence of neurological symptoms. CSF pleocytosis was seen early (CDC stage A), and may reflect the presence of HIV in the central nervous system (CNS) at the least stages of infection. We also confirmed the value of CSF β2m and neopterin as important markers of advancing disease stage. Whether they predict subclinical CNS involvement is to be determined by longitudinal observations. Conclusion. Neurological complains are common in medically asymptomatic HIV subjects whereas signs are not. The symptoms correlate with commonly determined independent measures of depression, anxiety, NP tests of fine motor speed and strength, as well as indices of disease worsening (CDC stage, serum β2m).

Two-year prospective study of major depressive disorder in HIV-infected men

“…Pleocytosis was defined as WBC > 4 cells/mL in CSF. Independently a neurologist, who was unaware of the results from other assessments (eg, SCID, neuropsychological, neuroimaging) conducted a neurological examination using previously described procedures (Heaton et al, 1995;Mehta et al, 1996) to globally rate the presence of any HIV-associated central or peripheral nervous system abnormality (present or absent).…”

HIV-infected persons with bipolar disorder are less aware of memory deficits than HIV-infected persons without bipolar disorder

“…For example, up to 52% of HIV individuals endorse neurocognitive complaints in everyday functioning including problems with multitasking, organizing day-to-day activities, processing complex information and perhaps most frequently, complaints in episodic memory (Maj et al, 1994; Stern et al, 1991; Mehta et al, 1996; Wilkins et al, 1991). Although several studies have reported a modest association between objective neuropsychological performance and self-reported cognitive complaints in HIV (Beason-Hazen, Nasrallah, & Bornstein, 1994; Mapou et al, 1993; Poutianinen & Elovaara, 1996; Stern et al, 1991), a large proportion have found no consistent relationship (Hinkin et al, 1996; Moore et al, 1997; van Gorp et al, 1991; Thames et al, 2010; Rourke et al, 1999a; Woods et al, 2007).…”

Pathogenic and protective correlates of T cell proliferation in AIDS. HNRC Group. HIV Neurobehavioral Research Center.

“…All subjects underwent comprehensive neuropsychological testing and a structured neurological examination, as described fully elsewhere (16). In brief, the neuropsychological examination consisted of tests that assessed eight ability areas: attention/speeded information processing, verbal/language skills, abstraction ability/executive functions, memory (learning of new information, recall of previously learned information), complex perceptual/motor abilities, simple motor skills, simple sensory functioning.…”

“…The structured neurological examination was performed by a research neurologist or trained research nurse, and covered the following areas: mental status, cranial nerves, sensory abnormality, motor strength, coordination, gait, abnormal movements, tendon reflexes, and release signs (primitive reflexes) (16). As for the neuropsychological evaluation, the neurological results were summarized as a glo-bal rating of neurological abnormality, on a 4-point scale, ranging from 0 for no abnormality to 3 for multiple severe abnormalities.…”