Kocsis A, Winwood MA, Hopper C, Peters B, Pinching A, Hay P, Goldmeier D; International Conference on AIDS.

Int Conf AIDS. 1991 Jun 16-21; 7: 79 (abstract no. TH.B.92).

Department of Psychology, St. Mary's Hospital, London, UK

BACKGROUND: The efficacy of Zidovudine in improving CNS functioning directly has been widely promoted. However, support for such a belief is poor since: 1) The extent to which improvement is due to systemic factors rather than direct CNS effects is unproven; 2) Published studies have disregarded the fact that the learning curve of HIV+ cognitively impaired at baseline differs significantly from those normal at baseline, creating the effect of spurious improvement; 3) The extent to which Zidovudine can penetrate the central nervous system in humans is uncertain. These considerations are substantial given the advent of other potentially centrally acting drugs and a predicted increase in HIV+ surviving the CNS impairment. METHOD: This paper describes a controlled longitudinal study comparing change in neuropsychological functioning of CDC Group IV patients enrolled on two separate drug trials examining the effects of a) Zidovudine (N=54) b) Amoxil v placebo (N=23). Changes in performance were compared with a control group of HIV negatives (N=45). Subjects were followed over repeated tests (total number of test sessions = 474) allowing detailed statistical analysis of trends in performance in each group. Immunological and clinical information on each HIV seropositive was collected. The neuropsychological battery included widely used tests such as Trail-Making and WAIS-R Digit Symbol as well as specially designed computer administered tests of reaction time, motor functioning and attention. RESULTS: Changes on different neuropsychological tests show a complex pattern. Those impaired at baseline show most variability. While there was sharp initial improvement in some patients on Zidovudine therapy this was also apparent in some of the Group IV patients on Amoxil. Improvements in those with normal or close to normal functioning at baseline were more likely to be maintained than in those with initial impairment. Maximum improvement was apparent 4 months after commencing treatment with Zidovudine and this was in line with immunological functioning. The predictive value of different tests will be shown. CONCLUSION: Claims of the efficacy of Zidovudine on CNS functioning must be treated with caution. Predictions can be made as to which patients are most likely to maintain cognitive improvement with treatment and this has implications for asymptomatic trials as well as future antiretroviral use.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Affect
• HIV Infections
• HIV Seropositivity
• Humans
• Longitudinal Studies
• Neuropsychological Tests
• Reaction Time
• Zidovudine
• methods
• physiology
• therapy

Other ID:

• 4009291

UI: 102196836

From Meeting Abstracts