Publication Abstract Display
Type: Published Abstract
Title: Clinically unrecognized cytomegalovirus brain infection at autopsy is associated with neurocognitive impairment in AIDS.
Authors: Ellis R, McCutchan J, Grant I
Year: 1995
Publication: 2nd National Conference on Human Retroviruses and Related Infections
Volume: Issue: Pages:
Abstract:Undiagnosed cytomegalovirus encephalitis (CMV-E) may cause cognitive impairment otherwise attributable to HIV-1 itself (HIV-associated dementia complex, HADC; HIV-associated minor cognitive-motor disorder, MCMD). We analyzed data from 26 AIDS patients with neurocognitive diagnoses based on prospective clinical and neurospsychologic data gathered by the HNRC. We hypothesized a significant association between CMV-E pathology and neurocognitive impairment during life. Brains were classified neuropathologically as having either parenchymal HIV involvement (HIV-E) alone (6 cases), CMV-E alone (4 cases); both HIV-E and CMV-E (6 cases); or neither (10 cases). At the clinical evaluation closest to death, 3/26 patients (12%) met criteria for HADC and 11 (42%) for MCMD. The proportion of cases with HADC or MCMD was higher among those with CMV-E (odds ratio 19.8, 95% CI 1.9-201.6). HIV-E was not significantly associated with neurocognitive impairment (odds ratio 2.7; 95% CI 0.54-13.2). The risk of cognitive impairment associated with CMV-E was 7-fold higher than that associated with HIV-E. After excluding 3 cases with frank clinical dementia, mild neurocognitive dysfunction (MCMD) was present in a higher proportion of cases with CMV-E than those without; this association approached statistical significance (odds radio 5.1: 95% CI 0.92-28.6). We conclude that unrecognized CMV encephalitis may be an important cause of both mild and severe neurocognitive impairment in patients with advanced HIV infection.

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