AEGiS-11IAC: Variation in clinical progression of HIV-associated dementia.

11th International AIDS Conference


Vancouver, British Columbia — July 7-12, 1996

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Variation in clinical progression of HIV-associated dementia.

Int Conf AIDS 1996 Jul 7-12; 11:222 (abstract no. Th.B.185)
Bouwman FH, Skolasky R, Dal Pan G, Glass J, Selnes OA, McArthur JC; Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA. Fax: (410) 955-0672.

OBJECTIVE: To characterize the clinical course of HIV-associated dementia (HAD), and to identify predictive markers of rapid progression.

METHODS: A prospective, consecutive series of 71 patients diagnosed with HAD (1984-1994) through the Johns Hopkins University HIV Neurology Program. Autopsy was performed in 38 of the individuals. The rate of neurological progression was determined from the monthly change in the dementia severity score (MSK) followed from diagnosis to death. The tertile with the most rapid progression (RP) was compared to that with the slowest progression (SP).

RESULTS: A mean survival times were 3.7 (plus or minus 2.0 months) and 13.3 (plus or minus 17.8 months) for RP and SP respectively. Among RP the average monthly change in MSK was 0.617 (plus or minus 0.429) compared to 0.004 (plus or minus 0.012) among SP. A significant association was noted between RP and injection drug (IDU) use (OR=6.0, p=0.05), but not with race or age. There were no female SP. CD4 counts were significantly lower at diagnosis among RP (58 plus or minus 73) compared to SP (252 plus or minus 336, p=0.03), but no differences in AIDS-defining illnesses or prior antiretroviral use were found. RP had more prominent mental slowing (OR=8.3, p=0.03), but no other clinical features, CSF constituents nor white matter hyperintensities on MRI or CT scans distinguished RP from SP. At autopsy no histopathological differences were noted between RP and SP.

CONCLUSIONS: Presentation with prominent psychomotor slowing and history of IDU were predictive of rapid neurologic progression in HIV dementia. Although a significant proportion of demented individuals have slower progression, these data support that the rate of neurologic deterioration parallels progression of immunosuppression. Future neurological therapies should be focussed on individuals at high risks for RP.

Keywords: AEGIS, AIDS Dementia Complex, HIV Infections, CD4 Lymphocyte Count, HIV-1, HIV Core Protein p24, HIV Envelope Protein gp41, HIV Envelope Protein gp120, HIV, HIV Seropositivity, Prognosis, Female, Human, cerebrospinal fluid, diagnosis, ICA11KWDaegis,aidsdementiacomplex,hivinfections,cd4lymphocytecount,hiv-1,hivcoreproteinp24,hivenvelopeproteingp41,hivenvelopeproteingp120,hiv,hivseropositivity,prognosis,female,human,cerebrospinalfluid,diagnosis,ica11

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ThB185

Copyright © 1996 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.