A PROSPECTIVE RADIOLOGIC AND NEUROLOGIC FOLLOW-UP-STUDY OF 61 HIV-1-INFECTED SUBJECTS - EARLY BEGINNING AND SLOW PROGRESSION OF BRAIN ATROPHY

The course of the organic brain disease caused by human immunodeficien cy virus (HIV-1) was evaluated in a follow-up study. The primary mater ial included 200 consecutive HIV-1 infected persons. Sixty-one subject s, in whom other brain-affecting factors were excluded, consented to t he follow-up. They underwent 278 radiologic examinations: computed tom ography, magnetic resonance imaging, or a combination of both (mean 4. 6 examinations/subject). Clinical neurologic status and, in 40 subject s, cognitive performance were repeatedly evaluated. Sixteen subjects w ere followed up until death and 11 of them were autopsied. Median foll ow-up time was 27 mo (range 2.5-66 mo). The most common radiologic fin ding was atrophy, found in 19 subjects at study entry and developing i n 10 subjects during the study. Twenty-four subjects (39%) showed the development and/or progression of atrophy. Atrophic changes progressed most rapidly in acquired immunodeficiency syndrome (AIDS), but mild d eveloping/progressive atrophy was found even in 33% of asymptomatic or neurologically intact subjects. Cognitive and radiologic worsening we re simultaneous in 6/7 subjects with declining neuropsychologic test p erformance. Signal intensity changes including HIV-1 leukoencephalopat hy appeared in AIDS patients with clear cognitive decline.