Low prevalence of neurological and neuropsychological abnormalities in otherwise healthy HIV‐1–infected individuals: Results from the multicenter AIDS cohort study

TLDR

Accurate description of the prevalence of neurological impairment in healthy HIV‑1 infected individuals is important for public health, employment, and future health planning, and confounding factors such as substance abuse must be considered. The study assessed the cross‑sectional prevalence of neurological abnormalities among 270 HIV‑1 seropositive men compared with 193 seronegative controls. The authors performed a neurological and neuropsychological screening battery and, for 119 abnormal cases, conducted additional neuropsychological tests and neurological examinations. No significant differences in neuropsychiatric symptoms or neuropsychological performance were observed; only one mild HIV‑related dementia case (prevalence 3.7/1,000) was identified, and most abnormalities—including MRI white‑matter changes and CSF abnormalities—were attributed to non‑HIV causes, indicating a very low prevalence of HIV‑related neurological disorders.

Abstract

Accurate description of the prevalence of neurological impairment in healthy individuals who are infected with human immunodeficiency virus type 1 (HIV-1) has relevance for public health policy, for employment issues, and for planning future health needs. Within the Multicenter AIDS Cohort Study, we determined the cross-sectional prevalence of neurological abnormalities in 270 HIV-1 seropositive homosexual and bisexual men in Centers for Disease Control Groups II and III, using a control group of 193 HIV-1 seronegative homosexual men. Utilizing a neurological and neuropsychological screening battery, we found no differences in the prevalence of neuropsychiatric symptoms or in neuropsychological performance. One hundred nineteen subjects with abnormalities on screening tests completed additional neuropsychological testing and had neurological examinations. The majority had normal results and the frequency of neurological abnormalities and impaired neuropsychological performance was not significantly increased among HIV-1 seropositive subjects. Most of the abnormalities could be attributed to causes other than HIV-1. One subject had mild HIV-1-related dementia, yielding a prevalence of 3.7:1,000 (95% confidence interval: 0.19-23.7:1,000). Magnetic resonance imaging demonstrated sulcal prominence and focal areas of high signal intensity in white matter in 63% of HIV-1 seropositive subjects and 48% of uninfected control subjects. Abnormalities in cerebrospinal fluid were noted in 23 (85%) of 27 HIV-1-infected individuals. Our studies indicate that the prevalence of dementia and other HIV-1-related neurological disorders is very low among healthy HIV-1 seropositive homosexual men. The confounding effects of factors such as substance abuse or preexisting medical conditions must be considered in the neurological evaluation of such patients.