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Neurocognitive dysfunction predicts postmortem findings of HIV encephalitis
M Cherner1, E Masliah, R J Ellis
1Departments of Psychiatry, University of California at San Diego, CA 92103, USA. mcherner@ucsd.edu
Neurology
|November 27, 2002
Summary
Antemortem cognitive assessments accurately predict postmortem HIV encephalitis (HIVE). Neuropsychological testing aids in identifying HIV-positive patients needing central nervous system disease treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Neuropsychology
Background:
- HIV encephalitis (HIVE) is a serious complication of HIV infection.
- Early detection of HIVE is crucial for effective management.
- Antemortem cognitive functioning may serve as an indicator for HIVE.
Purpose of the Study:
- To evaluate the predictive value of cognitive function assessments performed before death for identifying postmortem evidence of HIV encephalitis (HIVE).
Main Methods:
- A cohort of 39 subjects underwent comprehensive neuropsychological testing within 18 months of autopsy.
- Cognitive impairment was diagnosed using blind clinical ratings based on demographically corrected scores.
- HIVE was confirmed postmortem through immunocytochemistry for gp41, HIV RNA PCR, and histopathological analysis.
Main Results:
- Neurocognitive impairment demonstrated a sensitivity of 67% and specificity of 92% for detecting HIVE.
- 18 out of 19 subjects with pre-death cognitive impairment showed evidence of HIV-related brain disease, yielding a positive predictive value of 95%.
Conclusions:
- Neuropsychological assessments are valuable tools for identifying HIV-positive individuals with central nervous system (CNS) disease.
- These assessments can assist in selecting patients who would benefit from targeted CNS disease treatment.