Multivariate analysis of primitive reflexes in patients with human immunodeficiency virus type-1 infection and neurocognitive dysfunction

To prove that primitive reflexes are independent markers of symptomatic hum an immunodeficiency virus type-1 (HIV-1) infection, a case-control study wa s carried out in a tertiary care, university teaching hospital. Thirty HIV- 1-positive symptomatic cases, 30 seropositive asymptomatic controls and 30 HIV-1 seronegative controls consented to participate and were selected cons ecutively. A single examiner blinded to serostatus administered the Mini-Me ntal State Exam and a structured neurological exam to each participant. Up to 45% of cases had cognitive impairment. The occurrence of neurologic sign s between seropositive cases and seropositive controls was similar, but the number of primitive reflexes was significantly higher in cases (P < 0.001) . By multivariate discriminant analysis, all primitive reflexes but two cor rectly classified 83.3% of all participants (P = 0.0013). The model had a p ositive predictive value of 97% when motor, mood, and cognitive symptoms we re added (P = 0.0001). Primitive reflexes were independent predictors of HIV-1 serostatus, especia lly for those with cognitive dysfunction. Primitive reflexes should be incl uded in future case definitions of HIV-1-related neurocognitive disorders.