This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Irina Elovaara, MD; Erja Poutiainen, MA; Juhani Lähdevirta, MD; Laura Hokkanen, MA; Raili Raininko, MD; Satu Mattinen, MD; Ansa Virta, MD; Jukka Suni, MD; Annamari Ranki, MD

Arch Neurol. 1994;51(9):943-950.

Abstract
Objective
To evaluate the effect of zidovudine on human immunodeficiency virus type 1 (HIV-1)—associated central nervous system infection in Centers for Disease Control and Prevention stage II or III disease.

Design
In an open-ended trial, patients received 500 mg of zidovudine twice a day for 12 months. Lumbar punctures, neurological, neuropsychological, and neuroradiological examinations were repeatedly performed during the trial period and were compared with pretrial values. In 11 patients posttrial neurological follow-up of 10 to 20 months was performed.

Patients
Initially, 14 volunteers with stage II or III disease and intrathecal synthesis of HIV-1—specific antibodies were enrolled. Additionally, patients had slight neuropsychological disturbance or brain atrophy unrelated to other agents than HIV-1. Two patients dropped out because of poor compliance.

Main Outcome Measures
Intrathecal and systemic immune and virological responses, cognitive performance, and brain images were repeatedly monitored.

Results
After 6 weeks of zidovudine therapy, initial low-grade pleocytosis and elevated levels of β₂-microglobulin, both in cerebrospinal fluid and in serum samples, declined. Intrathecal HIV-1 antibody synthesis could no longer be detected in half of the patients after 12 months of zidovudine therapy. Patients with defective cognition transiently improved cognitive speed and flexibility after 6 months of therapy. Slight atrophic brain changes, however, remained unchanged.

Conclusions
Zidovudine reduces intrathecal immuno-activation and transiently improves cognitive functioning in HIV-1-infected subjects who show evidence of central nervous system involvement by HIV-1 but are otherwise asymptomatic.

Author Affiliations
From the Departments of Infectious Diseases (Drs Elovaara and Lähdevitra and Mss Poutiainen and Hokkanen) and Microbiology (Drs Elovaara and Suni), Aurora Hospital, Helsinki, Finland; the Department of Neurology, Tampere (Finland) University Hospital (Dr Elovaara); the Departments of Neurology (Mss Poutiainen and Hokkanen), Radiology (Dr Raininko), and Dermatology and Venereal Diseases (Dr Ranki), Helsinki University Central Hospital; the Institute of Biomedical Sciences, University of Tampere (Finland) (Dr Mattinen); and the Department of Radiology, Kivelä Hospital, Helsinki (Dr Virta).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?