Stern Y, Marder K, Bell K, Chen J, Dooneief G, Goldstein S, Mindry D, Richards M, Sano M, Williams J
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY.
Arch Gen Psychiatry. 1991 Feb;48(2):131-8. doi: 10.1001/archpsyc.1991.01810260039006.
We explored the possibility that neurologic and neuropsychological changes constitute the earliest detectable manifestations of human immunodeficiency virus (HIV) infection. Without knowledge of HIV status, we assessed neurologic signs and symptoms and administered a battery of neuropsychological tests to 208 homosexual men, of whom 84 were HIV negative, 49 were HIV positive and asymptomatic, 29 were mildly symptomatic, and 46 had significant medical symptoms but not the acquired immunodeficiency syndrome. There was no difference between the HIV-negative and HIV-positive men in the frequency of neurologic signs or of defective or borderline performance on any neuropsychological test. However, HIV-positive men performed slightly but significantly worse than HIV-negative men on tests of verbal memory, executive function, and language. Similar results were obtained when comparisons were limited to HIV-positive medically asymptomatic and HIV-negative men. There was no degradation of neurologic status or neuropsychological performance across stages of HIV severity, but neurologic and neuropsychological summary scores correlated with CD4/CD8 ratios in the HIV-positive group. Ratings of neurologic signs and symptoms correlated with neuropsychological summary scores in the HIV-positive group only. Cognitive complaints were more frequent in the HIV-positive men; they correlated with actual test performance in the HIV-positive but not HIV-negative men. The constellation of subjective and objective neuropsychological and neurologic findings suggests the possibility of a definable syndrome associated with HIV infection in asymptomatic individuals.
我们探讨了神经学和神经心理学变化是否构成人类免疫缺陷病毒（HIV）感染最早可检测到的表现这一可能性。在不了解HIV感染状况的情况下，我们对208名同性恋男性进行了神经学体征和症状评估，并实施了一系列神经心理学测试，其中84人HIV阴性，49人HIV阳性且无症状，29人有轻微症状，46人有明显医学症状但未患获得性免疫缺陷综合征。在神经学体征的出现频率或任何神经心理学测试中表现缺陷或临界方面，HIV阴性和HIV阳性男性之间没有差异。然而，在言语记忆、执行功能和语言测试中，HIV阳性男性的表现略逊于HIV阴性男性，但差异显著。当比较仅限于HIV阳性且无医学症状的男性和HIV阴性男性时，也获得了类似结果。在HIV严重程度的各个阶段，神经学状态或神经心理学表现均未出现退化，但在HIV阳性组中，神经学和神经心理学综合评分与CD4/CD8比值相关。仅在HIV阳性组中，神经学体征和症状评分与神经心理学综合评分相关。HIV阳性男性中认知方面的主诉更为频繁；它们与HIV阳性男性而非HIV阴性男性的实际测试表现相关。主观和客观的神经心理学及神经学发现表明，无症状个体中可能存在与HIV感染相关的可定义综合征。
