Neurological symptoms, not signs, are common in early HIV infection

P. Mehta, S. J. Gulevich, L. J. Thal, H. Jin, J. M. Olichney, J. A. McCutchan, R. K. Heaton, D. Kirson, G. Kaplanski, J. Nelson, J. H. Atkinson, M. R. Wallace, I. Grant

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Objective. To examine the cross-sectional prevalence of neurological symptoms and signs in a large cohort of human immunodeficiency virus (HIV)- seropositive men, and determine the relationship of the symptoms to disease stage, immunologic markers, and independent variables from neuropsychological (NP) testing and psychiatric interview. Methods. 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 era more extensive battery. A large subset (N = 377) underwent lumbar puncture for cerebrospinal fluid (CSF) 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 system 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 earliest 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 complaints 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).

Original languageEnglish (US)
Pages (from-to)67-85
Number of pages19
JournalJournal of Neuro-AIDS
Volume1
Issue number2
StatePublished - 1996

    Fingerprint

Keywords

  • β2 microglobulin
  • AIDS
  • HIV

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Mehta, P., Gulevich, S. J., Thal, L. J., Jin, H., Olichney, J. M., McCutchan, J. A., Heaton, R. K., Kirson, D., Kaplanski, G., Nelson, J., Atkinson, J. H., Wallace, M. R., & Grant, I. (1996). Neurological symptoms, not signs, are common in early HIV infection. Journal of Neuro-AIDS, 1(2), 67-85.