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1994-10-25
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Document 2930
DOCN M94A2930
TI HIV independent factors influencing neuropsychological performance in
ARC and AIDS individuals.
DT 9412
AU Dally LG; Chiesi A; Tomino C; Floridia M; Seeber A; Vella S; ISS, Lab.
of Virology, Rome, Italy.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):192 (abstract no. PB0198). Unique
Identifier : AIDSLINE ICA10/94369645
AB INTRODUCTION: Our previous studies on the epidemiology of ADC in Italy
(16813 pts. diagnosed between August 1987 and December 1993) showed that
ADC, as the first AIDS defining disease, occurred in 9.1% IVDU's vs 5.2%
homosexuals, the two groups being similar for mean CD4+ cell count. This
finding rose the question of which factors could account for the higher
incidence of ADC in the IVDU population. OBJECTIVE: To investigate the
possible role of HIV independent factors in influencing
neuropsychological performance and thus, indirectly, the diagnosis of
AIDS dementia complex (ADC). METHODS: We analyzed data on 412 patients
enrolled between Oct. 1990 and Dec. 1992 in two AZT vs DDI randomized,
multicenter trials. The present analysis is of baseline data only.
Together with clinical and haematoimmunological data, baseline
information included score for Mini-Mental Status (MMS), Digit Symbol
(DSY) and Timed Gait (TIG) tests, ADC stadiation, Mood score, number of
years of education and history of alcohol or drug abuse. Ordered
categorical data (DSY, TIG and MMS) were analysed using the Multiple
Proportional Odds regression model (McCullagh), while Mood was analysed
using a multiple logistic regression model. RESULTS: Of the 412 patients
90 (22%) were AIDS at baseline, 120 (29%) were females, 243 (59%) were
IVDU and 71 (17%) were homosexuals. A total of 61 (15%) admitted being
alcoholics while 110 (27%) were classified as being in some state of
affective disorder. The analysis of the age-adjusted scores for DSY
showed that patients with higher literacy and greater CD4+ cell counts
were more likely to have no deficit (p < 0.001), while IVDU's were
likely to perform worse than homosexuals (p < 0.029). Multiple logistic
regression on scores for TIG failed to identify any variable associated
with performance. A multiple proportional odds regression analysis on
scores for MMS showed that alcoholics tend to score less (p < 0.005) and
subjects with a greater number of years of education and a larger CD4+
cell count tend to score more (p < 0.009 for both). Finally, Mood at
study entry seems to be independently associated only with gender and
AIDS condition, the chances of being depressed being 1.77 times greater
for AIDS subjects vs. ARC and 1.63 times greater for females vs males.
DISCUSSION: Our results show that specific and non-HIV related factors,
namely, the number of years of education, drug and alcohol abuse, may
affect performance in these tests. Considering that the diagnosis of ADC
is predominantly clinical our study demonstrates that clinical and test
assisted diagnoses of cognitive impairment may be biased when applied to
patients with little schooling and/or a history of drug or alcohol
abuse.
DE Acquired Immunodeficiency Syndrome/*DIAGNOSIS/DRUG THERAPY/ PSYCHOLOGY
Adult Alcoholism/COMPLICATIONS/PSYCHOLOGY AIDS Dementia
Complex/*DIAGNOSIS/DRUG THERAPY/PSYCHOLOGY AIDS-Related
Complex/*DIAGNOSIS/DRUG THERAPY/PSYCHOLOGY Comparative Study
Didanosine/THERAPEUTIC USE Female Homosexuality Human Male
Neuropsychological Tests/*STATISTICS & NUMER DATA Organic Mental
Disorders, Substance-Induced/DIAGNOSIS/PSYCHOLOGY Psychometrics
Substance Abuse, Intravenous/COMPLICATIONS/PSYCHOLOGY
Zidovudine/THERAPEUTIC USE CLINICAL TRIAL MEETING ABSTRACT
MULTICENTER STUDY RANDOMIZED CONTROLLED TRIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).