MOTOR ANALYSIS PREDICTS PROGRESSION IN HIV-ASSOCIATED BRAIN DISEASE

One hundred HIV-positive individuals without clinically evident centra l nervous system (CNS) deficits entered this follow-up study and were examined clinically and with a well-defined motor test battery every 3 months over 2 years or until they deceased. They underwent magnetic r esonance tomography once a year. None received any form of therapy at onset of the study. Three groups were analyzed: (A) patients without e lectrophysiologically detectable motor impairment (n = 23), (B) patien ts with electrophysiologically detectable motor impairment but no viro static medication (n = 33), and (C) patients with motor deficits under going AZT treatment (n = 44) after study onset. Group A patients, alth ough slightly deteriorating over time, had the best clinical and elect rophysiological outcome compared to the other groups, whereas group B patients deteriorated markedly in both clinical and electrophysiologic al tests, even though the majority did not develop cerebral complicati ons during the observation period. Those group C patients belonging to early CDC stages (II and III) improved electrophysiologically under A ZT therapy, while 76% of the patients in more advanced stages (CDC IVA -D) died of cerebral AIDS manifestations. Four patients of this group, being alive at the end of the study, were completely demented. It is suggested that early detectable motor impairment predicts future cereb ral involvement in AIDS. Late onset of virostatic treatment did not in fluence the clinical outcome.