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Relationship to Head Injury

Karen Marder, MD, MPH; Yaakov Stern, PhD; Renee Malouf, MD; Ming-Xin Tang, PhD; Karen Bell, MD; George Dooneief, MD; Waafa El-Sadr, MD; Scott Goldstein, MA; Jack Gorman, MD; Marcus Richards, PhD; Mary Sano, PhD; Stephan Sorrell, MD; George Todak, MSW; Janet B. W. Williams, DSW; Anke Ehrhardt, PhD; Richard Mayeux, MD

Arch Neurol. 1992;49(11):1169-1175.

Abstract
• We examined 99 human immunodeficiency virus (HIV)—negative and 122 HIV-positive intravenous drug users (IVDUs) without acquired immunodeficiency syndrome (AIDS) to determine whether HIV-positive IVDUs had more neurologic and neuropsychological impairment than their HIV-negative counterparts. Controlling for age, education, drug use, history of head injury, and interactions between head injury and HIV status and drug use, HIV-positive subjects had more extrapyramidal signs and frontal release signs. These findings persisted when asymptomatic HIV-positive subjects without systemic signs of infection and HIV-negative subjects were compared. Neurologic findings were more severe in those with more systemic illness. Among those reporting a history of head injury with loss of consciousness, neuropsychological performance was significantly worse in the HIV-positive subjects, and this increased with severity of illness. This was not true in the group without head injury, suggesting an interaction between history of head injury and the seropositive state. No relationship was noted between head injury and either drug use or HIV state. Therefore, subtle neurologic and neuropsychological abnormalities may precede clinical evidence of AIDS in IVDUs and may be more evident in those with head injury.

Author Affiliations
From the Departments of Neurology (Drs Marder, Stern, Malouf, Tang, Bell, Dooneief, Richards, Sano, and Mayeux and Mr Goldstein) and Psychiatry (Drs Stern, Gorman, Ehrhardt, Williams, and Mayeux and Mr Todak) and the Gertrude Sergievsky Center (Drs Marder, Stern, Tang, Richards, and Mayeux), Columbia University College of Physicians and Surgeons, the HIV Center for Clinical and Behavioral Studies, (Drs Marder, Stern, Malouf, Bell, Dooneief, El-Sadr, Gorman, Sano, Sorrell, Ehrhardt, Williams, and Mayeux and Messrs Goldstein and Todak), the New York (NY) State Psychiatric Institute, and the Harlem Hospital Center (Drs Malouf and El-Sadr) and the St Luke's/Roosevelt Hospital Center (Dr Sorrell), New York, NY.

Footnotes
Accepted for publication April 27, 1992.

Reprint requests to the Neurological Institute, 710 W 168th St, New York, NY 10032 (Dr Marder).

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