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Karen Marder, MD, MPH; Xinhua Liu, PhD; Yaakow Stern, PhD; Renée Malouf, MD; George Dooneief, MD, MPH; Karen Bell, MD; George Todak, CSW; Maryse Joseph, RN; Stephen Sorrell, MD; Wafaa El Sadr, MD; Janet B. W. Williams, DSW; Anke Ehrhardt, PhD; Zena Stein, MD; Jack Gorman, MD

Arch Neurol. 1995;52(12):1174-1182.

Abstract
Background
Although the proportion of cases of acquired immunodeficiency syndrome related to intravenous drug use has increased dramatically over the past decade, there has been no longitudinal examination of primary neurologic disease in this group.

Objective
To study the development of neurologic disease in human immunodeficiency virus (HIV)—negative and HIV-positive men and women who were intravenous drug users over a 3.5-year period.

Design

Prospective observational cohort study.

Setting
Subjects were recruited from an infectious disease clinic at a New York City Hospital or from a methadone maintenance program.

Participants
Ninety-nine HIV-negative (62 men and 37 women) and 124 HIV-positive (85 men and 39 women) intravenous drug users volunteered.

Main Outcome Measure
The development of clinically significant manifestations in six neurologic domains.

Results
With multivariate adjustment for current and past substance abuse, age, education, and head injury, we examined the odds of developing HIV-related neurologic disease. Extrapyramidal signs and reduced motor ability became increasingly apparent over time in HIV-infected men as their CD4 cell count declined and as the subjects developed the acquired immunodeficiency syndrome. Fewer neurologic signs were seen in the women.

Conclusions
The impact of HIV infection among intravenous drug users parallels that in homosexual men and is independent of alcohol and other drug use.

Author Affiliations
From the Departments of Neurology (Drs Marder, Stern, Malouf Dooneief, Williams, and Bell and Mr Todak) and Psychiatry (Drs Stern, Ehrhardt, Stein, Williams, and Gorman and Mr Todak), College of Physicians and Surgeons, the Gertrude H. Sergievsky Center (Drs Marder, Liu, Stern, Dooneief, Bell, and Stein); the HIV Center for Clinical and Behavioral Studies (Drs Marder, Liu, Stern, Malouf, Dooneief, Bell, Sorrell, El Sadr, Ehrhardt, Stein, Williams, and Gorman and Mr Todak and Ms foseph); the Division of Epidemiology, School of Public Health at Columbia University (Dr Stein); Harlem Hospital Center (Drs Malouf and El Sadr and Ms foseph); and St Luke's-Roosevelt Hospital Center (Dr Sorrell), New York, NY.

Footnotes
Deceased.

Accepted for publication June 16, 1995.

This research was supported by center grant P50-MH43520 from the National Institute of Mental Health/National Institute on Drug Abuse, Rockville, Md, to the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute in New York; by grant T32-MH19139 from the National Institute of Mental Health; and by grants 3-M01-RR00645 and AG 10963 from the National Institutes of Health, Bethesda, Md.

Reprint requests to Gertrude H. Sergievsky Center, 630 W168th St, Box 16, New York, NY 10032 (Dr Marder).

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