A FOLLOW-UP-STUDY OF NEUROPSYCHOLOGICAL FUNCTIONING IN AIDS-PATIENTS - PROGNOSTIC-SIGNIFICANCE AND EFFECT OF ZIDOVUDINE THERAPY

Thirty-three patients with AIDS were subjected to neuropsychological a nd immunological testing with semi-annual examinations over a two year period. No patient had signs of opportunistic infections or neoplasms in the CNS. Patients who were neuropsychologically impaired at the ti me of AIDS diagnosis (n = 12) survived for a significantly shorter per iod than did the non-impaired subjects (n = 21), and neuropsychologica l function at first test had a significant predictive value concerning survival time. The poor prognosis associated with impaired neuropsych ological status was seen also in patients treated with zidovudine (ZDV ). Of the 21 patients who started ZDV treatment shortly after the firs t neuropsychological examination, 12 were retested. Follow-up data sho wed that this group of patients had a significant improvement in neuro psychological functioning during the first 6 months. However, a decrea se in performance was observed at second follow-up. In the group not t reated with ZDV (n = 7), two initially normal patients developed signs of HIV-encephalopathy, while none of the initially normal ZDV-treated patients did so. This might suggest a prophylactic effect of ZDV on d evelopment of neuropsychological dysfunction. Changes in neuropsycholo gical test results were correlated with changes in serum concentration of neopterin irrespective of ZDV treatment, suggesting that monocyte/ macrophage activation may be involved in the pathogenesis of HIV-encep halopathy.