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Primitive reflexes in a case-control study of patients with advanced human immunodeficiency virus type 1
I W Tremont-Lukats1, G M Teixeira, D E Hernández
1Department of Neurology, University of Wisconsin Hospital and Clinics, Madison 53792-5132, USA. itremont@facstaff.wisc.edu
Insights
Primitive reflexes (PR) were significantly more frequent in patients with human immunodeficiency virus type 1 (HIV-1) infection, indicating a potential link to cognitive decline in advanced stages of the disease.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- Acquired immunodeficiency syndrome (AIDS) can affect neurological function.
- Primitive reflexes (PR) are typically present in infants and disappear with neurological maturation.
- The presence of PR in adults may indicate underlying neurological dysfunction.
Purpose of the Study:
- To estimate the frequency of nine primitive reflexes (PR) in patients with human immunodeficiency virus type 1 (HIV-1) infection.
- To assess the clinical value of PR in patients with advanced HIV-1 infection.
- To explore the association between PR and cognitive impairment in HIV-1-infected individuals.
Main Methods:
- A cross-sectional study involving 78 patients with HIV-1 infection (WHO clinical stage 3 or 4) and 81 seronegative controls.
- Standardized neurological examination to assess nine primitive reflexes.
- Mini-Mental State Examination (MMSE) to evaluate cognitive function.
Main Results:
- Primitive reflexes were found in 36% of HIV-1 patients versus 0% of controls (P<0.0001).
- PR were 2-36 times more frequent in HIV-1 patients, particularly glabellar, snout, Rossolimo, and digital signs.
- 92% of HIV-1 patients had at least two PR compared to 8% of controls (P<0.0001).
Conclusions:
- Primitive reflexes are significantly associated with cognitive decline in patients with advanced HIV-1 infection.
- PR may serve as potential indicators of HIV-1-associated cognitive/motor complex and neurocognitive disorders.
- Further research with larger cohorts and multivariate analysis is recommended to validate PR as biomarkers.
Abstract:
This study estimated the frequency of nine primitive reflexes (PR) and assessed their possible clinical value in a group of patients with acquired immunodeficiency syndrome. We studied 78 patients with human inmunodeficiency type 1 (HIV-1) infection in WHO clinical stage 3 or 4 and 81 matched seronegative controls. All participants were examined using a standardized neurological examination and the Mini-Mental State Examination. Cognitive impairment and PR was found in 36% of patients but in none of the controls (P<0.0001; logistic regression odds ratio: 14.7). Overall, PR were 2-36 times more frequent in patients with HIV-1 infection. This association was stronger for the glabellar, snout, Rossolimo, and digital signs. At least two PR were observed in 92% of patients vs. 8% of controls (P<0.0001; 95% confidence interval: 68%-100%; logistic regression odds ratio: 10.8). These data support the association of PR with cognitive decline in patients with advanced HIV-1 infection without overt neurological disease. Larger follow-up studies with multivariate techniques are needed to identify which PRs are useful as indicators of HIV-1-associated cognitive/motor complex and minor neurocognitive disorders.
