[Show abstract][Hide abstract] ABSTRACT: Objectives: To determine whether highly active antiretroviral therapy (HAART) is effective in HIV-associated neurocognitive impairment.
Design: An open label, prospective, observational study.
Methods: Since April 1996, 116 patients with advanced HIV infection, reverse transcriptase inhibitor (nRTI) experienced but protease inhibitor (PI) naive, were screened for the presence of neurocognitive impairment. Ninety patients with confounding neurological illness, opportunistic infections or drug abuse were excluded. The remaining 26 patients underwent comprehensive neuropsychological testing, and laboratory measures before, after 6 and after 15 months of treatment with one PI plus two nRTI.
Results: The prevalence of neurocognitive impairment decreased from 80.8% (baseline) to 50.0% (P<0.05) (sixth month) and to 21.7% (P<0.001) (15th month). Among the functions explored, the impairment of concentration and speed of mental processing decreased from 65.4 to 21.7% (P<0.01) and of memory impairment from 50 to 8.7% (P<0.01). Comparing baseline with the sixth and 15th month raw scores, a statistically significant improvement was seen in measures exploring concentration and speed of mental processing (P<0.05), mental flexibility (P<0.05), memory (P<0.05), fine motor functions (P<0.05) and visuospatial and constructional abilities (P<0.01). After 6 months of HAART patients with a normal neuropsychological examination had lower mean plasma viraemia (2.95 versus 3.97 log copies/ml, P<0.05) and greater mean log plasma HIV RNA changes from baseline (-1.84 versus -0.83 log copies/ml, P<0.05) than neuropsychologically impaired subjects.
Conclusion: HAART produces a positive and sustained effect on neurocognitive impairment in HIV-infected patients. A reduction of plasma viral load was associated with the regression of neuropsychological test abnormalities.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is, using different diagnostic procedures, to identify in a group of asymptomatic HIV-l-infected subjects - stages A1 and A2 of the CDC classification - early neurological, neuropsychological and ophthalmological signs of the HIV-1 infection. Relationship between cerebral perfusion abnormalities, neuropsychological assessment alterations and retinal microvascular disorders are analysed. 23 asymptomatic HIV-1-infected subjects, only in stages A1 and A2 of the CDC classification criteria, were evaluated using neuropsychometric tests; all underwent Single-Photon Emission Computed Tomography (SPECT), ophthalmic examination and Fluorescein Angiography (FAG). On psychometric testing 5 out of the 23 (21.7%) asymptomatic subjects had a mental decay percentage (MD%) >/20%. Cerebral perfusion abnormalities were detected in 17 out of the 23 (73.9%) subjects who underwent SPECT. Retinal microvascolar changes were noted in 7 out of the 23 (30.4%) patients examined by FAG. Relationship between cerebral and ocular perfusion were observed in 11 out of 23 (47.8%) patients examined; mental decay and ocular microvascolar changes were correlated in 15 cases (65.2%); mental decay and cerebral blood flow perfusion in 5 cases (21.7%). A relationship between cerebral and ocular perfusion and a close association between ocular perfusion and mental decay were demonstrated; less correlations between mental decay and cerebral perfusion were observed.
No preview · Article · Apr 1997 · Annali di ottalmologia e clinica oculistica
[Show abstract][Hide abstract] ABSTRACT: Zidovudine (ZDV) is an inhibitor of HIV replication that may have a beneficial effect on patients with AIDS dementia complex (ADC). However, little is known about the association between long-term ZDV treatment and severity of ADC, ZDV dose or clinical and laboratory response to therapy.
An open study on ZDV administration in 30 consecutive patients with ADC.
An infectious diseases hospital.
Thirty consecutive patients followed-up for 12 months.
Three oral ZDV doses were used: 1000 mg (nine patients), 750 mg (eight patients) and 500 mg (13 patients) per day, depending on haematological status.
Clinical and neurological examinations, neuropsychological evaluations, high-field brain magnetic resonance imaging (MRI) and 99mTc-HM-PAO single photon emission computerized tomography (SPECT).
A favourable clinical response, defined as reversal to a less severe ADC stage (Price and Brew's criteria), was observed after 1, 3, 6, 9 and 12 months in 15, 22, 25, 19 and 14 patients, respectively. Neither severity of ADC at entry nor ZDV dose correlated with response to treatment. Seven patients died during the 12-month follow-up. The only factor associated with longer survival was ADC severity at entry (12-month survival, 0.94 and 0.53, in patients in stages 1 or 2 and in stages 3 or 4, respectively; P < 0.01). After 6-12 months of ZDV treatment six patients who initially responded to therapy showed a relapse in initial ADC stage, and two patients a less severe neurological deterioration. Neuropsychological evaluations showed significant improvement in the Wisconsin Card-Sorting test (P = 0.006 for categories, P = 0.029 for perseverative errors), which is particularly sensitive to cognitive and frontal-lobe type functions. Brain MRI revealed a reduction of the extent of white matter lesions in six out of 13 patients, who also showed clinical improvement. SPECT scanning revealed a reduction in the extent of uptake defects concomitant with clinical response in nine out of 14 patients.
ZDV is effective in most patients with mild to end-stage ADC, although the benefit is sometimes only transient; several relapses and deaths occurred after the sixth month of treatment.
[Show abstract][Hide abstract] ABSTRACT: To determine the optimal diagnostic procedures for identifying early signs of AIDS dementia complex (ADC) in asymptomatic HIV-1-infected individuals, in order to prevent further cognitive function impairment by early treatment.
Study patients had been referred electively and consecutively to hospital; all had been referred for the first time and gave informed consent. Inclusion criteria were (1) lack of history and/or symptoms of psychosis and neurological disorders; (2) lack of active viral, protozoan or fungal pathology; (3) abstinence from heroin and/or cocaine for at least 6 months before baseline evaluation.
Subjects were seen at the L. Spallanzani Hospital for Infectious Diseases, Rome, Italy between March 1989 and March 1991.
Eighty-two asymptomatic HIV-1-infected subjects: 41 drug users, 27 homosexuals and 14 heterosexuals.
All subjects were evaluated using Wechsler-Bellevue I, Benton C form and Bender tests. Thirty-nine subjects underwent single-photon emission computed tomography (SPECT) and 12 magnetic resonance imaging (MRI). The immunological status of each subject was determined.
On psychometric testing, 23 out of the 82 (28%) asymptomatic subjects had a mental decay percentage (MD%) > or = 20%. Cerebral perfusion abnormalities were detected in 31 out of 39 (79.48%) subjects who underwent SPECT; MRI abnormalities were observed in seven out of 12 (58%) subjects. Twelve out of 23 subjects with MD% > or = 20, 15 out of 29 subjects with SPECT abnormalities and four out of seven patients with MRI abnormalities had total CD4+ lymphocyte counts > or = 500 x 10(6)/l.
The high incidence of abnormal SPECT and of MD% > or = 20 in asymptomatic HIV-1-infected patients, and the lack of correlation between immunological status and degree of mental decay, SPECT and MRI abnormalities raise many questions about subclinical HIV-1 neurological disease.
[Show abstract][Hide abstract] ABSTRACT: Cerebral blood flow (CBF) was evaluated by gamma camera 99mTc-HMPAO SPECT in 11 patients with AIDS-related neurotoxoplasmosis and correlated with neurological findings and the results of CT and MRI. Evident CBF abnormalities were observed in all patients with involvement of at least two cerebral lobes. In 10 patients the abnormalities were bilateral and in 8 patients basal ganglia were involved; no specific hypoperfusion pattern was however evident. Focal lesions were found in 7 patients by CT (sensitivity: 63.6%) and in 10 patients by MRI (sensitivity: 90.9%). It may be concluded that neurotoxoplasmosis in AIDS patients is associated with a high prevalence of focal cortical and subcortical hypoperfusion but that the scintigraphic findings are not specific; that HMPAO SPECT may show focal hypoperfusion in patients with normal CT studies and/or non-focal MRI abnormalities; that the hypoperfusion may be more extensive than the corresponding MRI lesion(s) and that it may be present even in areas with normal MRI signals; and that more experience and longitudinal studies are needed to assess the possible impact of HMPAO SPECT on follow-up and therapy monitoring.
[Show abstract][Hide abstract] ABSTRACT: Dementia complex is a syndrome that affects a high percentage of AIDS patients. Neuroradiological findings may be non-specific and the diagnosis can be difficult in its earlier stages. Preliminary radionuclide studies have recently reported derangements of regional cerebral blood flow (CBF) which may be present before overt anatomical injury. This study reports on cortical and cerebellar CBF changes in 26 patients studied with 99Tcm-HM-PAO and single photon emission computed tomography (SPECT). Extensive cortical CBF derangements were observed in all patients and an evident cerebellar hypoperfusion was also present in three. The prevalence of hypoperfusion was highest in the frontal and parietal lobes. The extension of the hypoperfusion showed a highly significant correlation with the severity of the dementia complex (P less than 0.01 by chi 2 test). The SPECT also showed hypoperfused areas in three patients with normal CT scans and in two patients with normal MRI scans. These results confirm previous preliminary reports on the high prevalence of cortical hypoperfusion in dementia complex and suggest the use of this radionuclide technique to assist in the early diagnosis and follow-up of AIDS patients, especially when CT and MRI are still normal.
No preview · Article · Oct 1990 · Nuclear Medicine Communications
[Show abstract][Hide abstract] ABSTRACT: Age-dependent changes of 99Tcm-DTPA radioaerosol transpulmonary clearance have been investigated in 49 healthy volunteers with an age range of 21-63 years. The clearance was uniformly increased in all smokers irrespective of age, but it showed a highly significant (p less than 0.001) decrease in non-smoking patients over 50 years. Several age-related changes in the ageing lung can contribute to this decreased clearance, but the reduced alveolar-capillary surface area available for the transport is probably the key factor. The practical implication of the results is the need to use age-related normal ranges when interpreting 99Tcm-DTPA radioaerosol clearance studies.
No preview · Article · Jan 1989 · Nuclear Medicine Communications
[Show abstract][Hide abstract] ABSTRACT: This investigation was carried out to evaluate the plasma CEA and TPA levels in normal subjects and in 140 patients with lung cancer: 116 patients with nonsmall cell lung cancer (NSCLC) and 24 patients with small cell carcinoma (SCLC). The CEA and TPA levels were determined simultaneously by radioimmunoassay. The cutoff limit of CEA was found to be 17 U/SORIN, and the cutoff of TPA was 99 U/L. TPA has shown a sensitivity almost twice that of CEA. The relationship between the mean values of CEA and TPA and the stages of NSCLC was statistically significant (P less than 0.01), whereas only the mean values of TPA significantly (P less than 0.05) correlated with extensive and limited disease in SCLC. The determinations of combined CEA and TPA levels (CEA X TPA) (P less than 0.001) correlated significantly with the stage of disease in patients with NSCLC; conversely, the use of CEA X TPA did not correlate with the stage of SCLC.
No preview · Article · Feb 1985 · Cancer Detection and Prevention