J Neuropsychiatry Clin Neurosci 1989; 1:225-235
Copyright © 1989 by American Neuropsychiatric Association
Early neuropsychological dysfunction caused by human immunodeficiency virus
R Marotta and S Perry
Cornell University Medical College, New York, New York.
The human immunodeficiency virus (HIV), the etiological agent of acquired
immunodeficiency syndrome (AIDS), directly affects the central nervous
system (CNS) and often causes cognitive, motor, and behavioral changes and
eventually a dementia prior to death. Suggestive evidence for the early
onset of HIV-induced mental changes is derived from numerous case reports,
the nature of subcortical CNS postmortem findings, and early abnormalities
seen in cerebrospinal fluid, on brain computed tomography, magnetic
resonance imaging, and electroencephalography, and on neuropsychological
tests administered to patients with AIDS and AIDS-related complex. However,
whether clinically significant cerebral impairment can precede symptoms of
immunosuppression is unclear. A few studies have shown poorer performance
on neuropsychological tests by asymptomatic HIV-infected subjects compared
with uninfected controls, but several studies have not found this
difference. To address this controversy, the current literature is
reviewed, methodological problems are discussed, and recommendations are
made for evaluation and treatment when early HIV- induced mental changes
are suspected.
