Treatment Issues; Vol. 9, No. 3 - March 1995
Gabriel Torres

In an autopsy study performed by researchers at the University of California San Diego (abstract no. 288), either CMV or HIV was found in 62 percent of the brains of people with AIDS, with both viruses found in six of the 26 brains studied. CMV was associated with a seven-fold increase in the likelihood of significant cognitive impairment compared to HIV.

Since it is common to find upon autopsy subclinical cytomegalovirus (CMV) infection in the brains of patients with CMV retinitis, the same researchers performed neuropsychological tests in sixteen patients with CMV retinitis and no obvious dementia. They compared these patients' responses to those of 32 matched AIDS patients without CMV retinitis (abstract no. 289).

Those with retinitis were more likely to be cognitively impaired than the controls (69 percent versus 37 percent). Attention and verbal fluency were the areas with greatest intergroup difference. The observed impairment was not caused by anxiety or depression, poor vision or difference in baseline intelligence. MRI brain scans showed loss of central volume, suggesting focal destruction of brain tissue in the deep core structure.

The findings indicate that up to one-third of patients with CMV retinitis have an element of subclinical CMV encephalitis. It is uncertain how much anti-CMV treatment can help this condition.

Bartonella henslae and AIDS-related Psychosis

Bartonella henslae (previously called Rochlimea henslae) is a Gram-negative bacteria that causes cat scratch disease and bacillary angiomatosis (BA). BA is a rare skin disease appearing as grape-like violaceous nodules, often confused with Kaposi's sarcoma. It may be associated with liver disease (peliosis hepatitis), meningitis and bacteremia (detectable Bartonella levels in the blood).

At the National Retrovirus Conference, a study from the University of California at San Diego and Los Angeles (abstract no. 132) compared the prevalence of antibodies against Bartonella in the cerebrospinal fluid of patients with a history of HIV-related psychosis to those of patients with HIV without psychosis. Fifty percent of the HIV-positive patients with psychosis had Bartonella antibodies in their cerebrospinal fluid compared to none of the controls. The nature of the psychiatric disorders ranged from mania and bipolar disease to schizophrenia.

The psychotic patients were similar to the controls in terms of CD4 cell count, age and educational level. At present, the treatment for Bartonella includes such antibiotics as erythromycin and rifampin. Whether treatment with antibiotics could improve the psychiatric symptoms in these patients remains an unanswered question.

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