Fluctuations in HIV-1 Viral Load Are Correlated to CD4+ T-Lymphocyte Count During the Natural Course of Infection

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Abstract
Background:To find out about the prophylactic value of antiretroviral therapy on HIV-1-associated subclinical and clinical psychomotor slowing as one marker of HIV-1-associated CNS disease. Methods:Prospective study with regular clinical and neurophysiologic examination every three months of 1482 consecutive HIV-1-seropositive and AIDS patients seen at our department till June 30, 1999. Results:Antiretroviral therapy has a significant prophylactic value over an individual observation period of ten years with regard to the first, potentially transient manifestation of HIV-1-associated subclinical psychomotor slowing and with regard to the clinical manifestation of motor signs. However, a subgroup of patients is characterized through a second, more sustained manifestation of subclinical psychomotor slowing which cannot be prevented by any type of currently available antiretroviral therapy. Conclusions:These findings suggest the existence of different pathomechanisms underlying HIV-1-associated brain disease which may in part be effectively prevented, but which in part also escape all antiretroviral treatment strategies in use today. Address correspondence and reprint requests to H. J. v. Giesen, Department of Neurology, Heinrich-Heine-Universität, Düsseldorf, Postfach 10 10 07, D-40001 Düsseldorf, Germany; email: [email protected] uni-duesseldorf.de. Manuscript received November 2, 1999; accepted February 2, 2000. © 2000 Lippincott Williams & Wilkins, Inc.