Neurological and neuropshychological manifestations of HIV‐1 infection: Association with AIDS‐related complex but not asymptomatic HIV‐1 infection

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Abstract
To determine whether neurological and neuropsychological abnormalities are associated with clinical manifestations of human immunodeficiency virus type 1 (HIV‐1) infection in men who do not have acquired immunodeficiency syndrome (AIDS), we performed a historical prospective and cross‐sectional study. One hundred HIV‐1 seropositive homosexual or bisexual men, of whom 26 had AIDS‐related complex, 31 had generalized lymphadenopathy, and 43 had no signs or symptoms of HIV‐1 infection, and 157 HIV‐1 seronegative men were enrolled from a cohort of 6,701 men who were originally recruited between 1978 and 1980 for studies of hepatitis B virus infection. Evaluation included medical history, physical examination, and neuropsychological tests. Of 26 HIV‐1 seropositive subjects with AIDS‐related complex, 11 (42%) reported neurological, cognitive, or affective symptoms compared with 30 (19%) of 157 HIV‐1 seronegative subjects (relative risk ≈ 2.2, p = 0.02). On neuropsychological testing, subjects with AIDS‐related complex performed at a significantly lower level than the HIV‐1 seronegative group (p = 0.001). A significantly higher percentage of subjects with AIDS‐related complex (8[31%] of 26) than HIV‐1 seronegative subjects (19 [12%] of 157) had abnormal results on two or more neuropsychological tests (rate ratio = 2.5, p = 0.03). symptoms and impairment on neuropsychological tests were correlated only within the group who had AIDS‐related complex. Subjects with generalized lymphadenopathy and subjects who had no signs or symptoms of HIV‐1 infection were not different from HIV‐1 seronegative subjects with respect to symptoms or performance on neuropsychological tests. Absolute T‐helper lymphocyte count and estimated duration of HIV‐1 infection were not associated with neuropsychological test results. These findings suggest that neurological and neuropsychological abnormalities are associated with AIDS‐related complex but not with asymptomatic HIV‐1 infection.