Neurologic and neuropsychological manifestations of human immunodeficiency virus infection in intravenous drug users without acquired immunodeficiency syndrome. Relationship to head injury
K. Marder, Y. Stern, R. Malouf, M. X. Tang, K. Bell, G. Dooneief, W. el-Sadr, S. Goldstein, J. Gorman, M. Richards and al. et
Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY.
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.
