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M94A0704.TXT
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1994-10-21
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Document 0704
DOCN M94A0704
TI Transient ischaemic attacks (TIAs) in HIV infection.
DT 9412
AU Brew BJ; Miller J; HIV Medicine Unit, St Vincent's Hospital, Australia.
SO Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:29 (abstract no. TC7).
Unique Identifier : AIDSLINE ASHM5/94348951
AB OBJECTIVE: TIAs in HIV infection may occur as a result of an underlying
infection or neoplasm and seemingly as a consequence of HIV itself. The
frequency, clinical characteristics and results of investigations of
those TIAs that occur independent of an underlying infection or
neoplasm, however, have not been defined and so we sought to address
these issues in a prospective survey. METHODS: Cases were defined by the
following criteria: i) occurrence within a two year period, ii) a CT
brain scan that showed no abnormality apart from cerebral atrophy, iii)
occurrence of a neurological deficit lasting less than 24 hours and iv)
admission to hospital for evaluation of the deficit. A record of such
cases was kept by one investigator. To ensure that no cases had been
missed a retrospective analysis of all admissions to the HIV medicine
unit for the same two year period was undertaken. Those medical records
where there was a diagnosis of TIA were selected for further study. To
estimate the frequency of such TIAs the total number of admissions to
the HIV medicine unit for the same time period was obtained.
Additionally, to estimate the comparative frequency of TIAs in HIV
infection the number of patients with TIAs who did not have HIV
infection for the same time period and age range was obtained. RESULTS:
Ten cases were identified for the study period an no additional cases
were found by the retrospective survey. The mean age of the HIV related
TIAs was 40 +/- 11 and all were male. The admission frequency of HIV
relate TIAs per year to the HIV medicine unit was 0.6% as opposed to the
admission rate for age matched non HIV related TIA's to the Neurology
unit of 0.25%. All but 2 had CD4 counts less than 50. Half had frequent,
daily TIAs with 2 having alternate side TIAs but none had
vertebrobasilar territory events. None developed a permanent deficit.
Seven patients had platelet counts less than 100. Two of 6 patients had
low protein S levels while none of the 6 had low protein C levels. Four
of 7 patients had elevated levels of anticardiolpiin antibodies. One
patient had an echocardiogram showing changes consistent with a
cardiomyopathy. Six of the ten had moderately severe AIDS dementia
complex (ADC) and two had mild ADC. In only one patient was there
resolution no therapy whereas in 5 of the 5 patients who were able to
commence or resume either zidovudine or didanosine there was resolution
of the attacks. In the remaining 4 patients the TIAs persisted till
death. CONCLUSIONS: TIAs are more frequent in HIV infection especially
in the advanced phase. The TIAs are not associated clinically with
cerebral infarction but appear to be related to ADC, anticardiolipin
antibodies and thrombocytopenia. Treatment with antiretrovirals appear
to lead to resolution of the TIAs.
DE Adult AIDS Dementia Complex/*DIAGNOSIS/DRUG THERAPY Cerebral Ischemia,
Transient/*DIAGNOSIS/DRUG THERAPY/ETIOLOGY Didanosine/THERAPEUTIC USE
Human Leukocyte Count Male Middle Age Platelet Count Prognosis
Zidovudine/THERAPEUTIC USE MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).