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Dysfunction of visual pathways in HIV-1 infection

R Malessa1, M W Agelink, H C Diener

  • 1Department of Neurology, University of Essen, Germany.

Journal of the Neurological Sciences
|May 1, 1995
PubMed
Summary

Foveal and conventional visual evoked potentials (VEPs) show early optic nerve dysfunction in HIV-positive individuals. Zidovudine treatment may help preserve visual pathway function, warranting further investigation.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Infectious Diseases

Background:

  • Human immunodeficiency virus (HIV) infection can affect the visual system, potentially leading to optic neuropathy.
  • Early detection of subclinical visual pathway dysfunction is crucial for managing HIV-associated complications.

Purpose of the Study:

  • To investigate the utility of foveal (f-VEPs) and conventional full field (c-VEPs) pattern-shift visual evoked potentials in detecting subclinical optic nerve dysfunction in HIV-seropositive individuals.
  • To explore the relationship between CD4 cell counts, zidovudine treatment, and VEP parameters in HIV-1 infection.

Main Methods:

  • Bilateral f-VEPs and c-VEPs were recorded in 100 HIV-seropositive men and 40 healthy controls.
  • VEP parameters, including P100 latency and amplitude, were analyzed in relation to HIV status, CD4 cell counts, and zidovudine treatment.

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  • Multivariate analyses (MANCOVA) and Kruskal-Wallis tests were employed for statistical evaluation.

    • Main Results:

    • HIV-seropositive individuals exhibited significantly increased mean P100 latency in both f-VEPs and c-VEPs (p < 0.001).
    • f-VEPs detected early conduction changes in 17% of eyes in WR2 stage HIVs, compared to 3% with c-VEPs.
    • Reduced mean c-VEP amplitude (33%) was observed in patients with CD4 counts below 100/microliter (p < 0.01).
    • CD4 cell depletion was independently associated with lower VEP amplitudes (p < 0.01), while zidovudine treatment correlated with higher c-VEP amplitudes (p < 0.05).

    Conclusions:

    • f-VEPs are a sensitive tool for detecting subclinical optic fiber dysfunction in early HIV-1 infection.
    • Axonal loss in optic fibers becomes apparent with manifest immune deficiency.
    • The observed inverse correlation between VEP changes and zidovudine treatment suggests a potential neuroprotective effect of HIV replication inhibition on the visual pathway.