Journal of Neurology

, Volume 242, Issue 1, pp 20–25

HIV-specific changes in the motor performance of HIV-positive intravenous drug abusers

  • Hans-Jürgen von Giesen
  • Harald Hefter
  • Holger Roick
  • Stefan Mauss
  • Gabriele Arendt
Original Communication


Motor tests comprising the analysis of postural tremor, most rapid voluntary alternating index finger movements (MRAM) and the rise time of most rapid index finger extensions (CT) allow us to quantify HIV-associated minor motor deficits electrophysiologically. The electrophysiological results in 57 HIV-positive individuals who acquired HIV infection by intravenous drug abuse (IVDA) were compared with those of 57 matched HIV-positive homosexuals and 98 HIV-negative controls to evaluate a possible additional influence of IVDA on motor performance. Motor deficits showed no differences between HIV-positive IV drug abusers and homosexuals, revealing a highly significant slowing of MRAM and prolongation of CT to an almost identical extent. Thus, in HIV-infected individuals minor motor deficits are characteristic early signs of subclinical central nervous system involvement regardless of the mode of HIV infection.

Key words

HIV infection Motor performance Subclinical central nervous system involvement Intravenous drug abuse Homosexual control 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ambros RA, Lee EY, Sharer LR, Khan MY, Robboy SJ (1987) The acquired immunodeficiency syndrome in intravenous drug abusers and patients with a sexual risk: clinical and postmortem comparisons. Hum Pathol 18:1109–1114Google Scholar
  2. 2.
    American Academy of Neurology AIDS Task Force (1991) Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Neurology 41:778–785Google Scholar
  3. 3.
    Arendt G, Hefter H, Elsing C, Strohmeyer G, Freund HJ (1990) Motor dysfunction in HIV-infected patients without clinically detectable central-nervous deficit. J Neurol 237:362–368Google Scholar
  4. 4.
    Arendt G, Hefter H, Buescher L, Hilperath F, Elsing C, Freund HJ (1992) Improvement of motor performance of HIV-positive patients under AZT therapy. Neurology 42:891–895Google Scholar
  5. 5.
    Arendt G, Maecker HP, Jablonowski H, Hömberg V (1992) Magnetic stimulation of motor cortex in relation to fastest voluntary motor activity in neurologically asymptomatic HIV-positive patients. J Neurol Sci 112:76–80Google Scholar
  6. 6.
    Arendt G, Giesen HJ von, Hefter H, Mauss S (1993) Effects of long-term AZT, DDI and AZT/DDC combination treatment on electrophysiologically detectable CNS deficits in clinically asymptomatic HIV-positive patients. Clin Neuropathol 12 [Suppl 1]: S15Google Scholar
  7. 7.
    Arendt G, Hefter H, Neuen-Jacob E, Wist S, Kuhlmann H, Strohmeyer G, Freund HJ (1993) Electrophysiological motor testing, MRI findings and clinical course in AIDS patients with dementia. J Neurol 240:439–445Google Scholar
  8. 8.
    Boccellari AA, Dilley JW, Chambers DB, Yingling CD, Tauber MA, Moss AR, Osmond DH (1993) Immune function and neuropsychological performance in HIV-1-infected homosexual men. J Acquir Immun Defic Syndr 6:592–601Google Scholar
  9. 9.
    Brown SM, Stimmel B, Taub RN, Kochwa S, Rosenfield RE (1992) Immunologic dysfunction in heroin addicts. Arch Intern Med 134:1001–1006Google Scholar
  10. 10.
    Budka H, Wiley CA, Kleihues P, Artigas J, Asbury AK, Cho ES, Comblath DR, Dal Canto MC, DeGirolami U, Dickson D, Epstein LG, Esiri MM, Giangaspero F, Gosztonyi G, Gray F, Griffin JW, Hénin D, Iwasaki Y, Janssen RS, Johnson RT, Lantos PL, Lyman WD, McArthur JC, Nagashima K, Peress N, Petito CK, Price RW, Rhodes RH, Rosenblum M, Said G, Scaravilli F, Sharer LR, Vinters HV (1991) HIV-associated disease of the nervous system: review of nomenclature and proposal for neuropathology-based terminology. Brain Pathology 1:143–152Google Scholar
  11. 11.
    Chiodi F, Fenyö EM (1991) Neurotropism of human immunodeficiency virus. Brain Pathol 1:185–191Google Scholar
  12. 12.
    Des Jarlais DC, Friedman SR, Novick DM (1989) HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. JAMA 261:1008–1012Google Scholar
  13. 13.
    Donahoe RM, Falek A (1988) Neuroimmunomodulation by opiates and other drugs of abuse: relationship to HIV infection and AIDS. In: Brigde TP, Mirsky AF, Goodwin FK (eds) Psychological, neuropsychiatric, and substance abuse aspects of AIDS, vol 44. Raven Press, New York, pp 145–158Google Scholar
  14. 14.
    Dooneief G, Bello J, Todak G, Mun IK, Marder K, Malouf R, Gorman J, Hilal S, Stern Y, Mayeux R (1992) A prospective controlled study of magnetic resonance imaging of the brain in gay men and parenteral drug users with human immunodeficiency virus infection. Arch Neurol 49:38–43Google Scholar
  15. 15.
    Egan V, Brettle RP, Goodwin GM (1992) The Edinburgh Cohort of HIV-positive drug users: pattern of cognitive impairment in relation to progression of disease. Br J Psychiatry 161:522–531Google Scholar
  16. 16.
    Gendelman H, Phelps W, Feigenbaum L, Ostrove JM, Adachi A, Howley PM, Khoury G, Ginsberg HS, Martin MA (1986) Transactivation of the human immune deficiency virus long terminal repeat sequence by DNA viruses. Trans Natl Acad Sci USA 83:9759–9763Google Scholar
  17. 17.
    Goethe KE, Mitchell JE, Marshall DW, Brey RL, Cahill WT, Leger D, Hoy LJ (1989) Neuropsychological and neurological function of human immunodeficiency virus seropositive asymptomatic individuals. Arch Neurol 46:129–133Google Scholar
  18. 18.
    Grant I, Adams KM, Carlin AS, Rennick PM (1977) Neuropsychological deficit in polydrug users. A preliminary report of the findings of the collaborative neuropsychological study of polydrug users. Drug Alcohol Depend 2:91–108Google Scholar
  19. 19.
    Grant J, Atkinson JH, Hesselink JR, Kennedy CJ, Richman DD, Spector SA, McCutchan JA (1987) Evidence for early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Ann Intern Med 107:828–836Google Scholar
  20. 20.
    Janssen RS, Saykin AJ, Cannon L, Campbell J, Pinsky PF, Herrol NA, O'Malley PM, Lifson AR, Dole LS, Rutherford GW, Kaplan JE (1989) Neurological and neuropsychological manifestations of HIV-1 infection: association with AIDS-related complex but not asymptomatic HIV infection. Ann Neurol 26:592–600Google Scholar
  21. 21.
    Kaslow RA, Blackwelder WC, Ostrow DG, Yerg D, Palenicek J, Coulson AH, Valdiserri RO for the MACS (1989) No evidence for a role of alcohol or other psychoactive drugs in accelerating immunodeficiency in HIV-1-positive individuals. JAMA 261:3424–3429Google Scholar
  22. 22.
    Lunn S, Skydsbjerg M, Schulsinger H, Parnas J, Pedersen C, Mathiesen L (1991) A preliminary report on the neuropsychologic sequelae of human immunodeficiency virus. Arch Gen Psychiatry 48:139–142Google Scholar
  23. 23.
    Malouf R, Jacquette G, Dobkin J, Brust JCM (1990) Neurologic disease in human immunodeficiency virus-infected drug abusers. Arch Neurol 47:1002–1007Google Scholar
  24. 24.
    Marder K, Stern Y, Malouf R, Tang MX, Bell K, Dooneief G, El-Sadr W, Goldstein S, Gorman J, Richards M, Sano M, Sorrell S, Todak G, Williams JBW; Ehrhardt A, Mayeux R (1992) Neurologic and neuropsychological manifestations of human immunodeficiency virus infection in intravenous drug users without acquired immunodeficiency syndrome. Arch Neurol 49:1169–1175Google Scholar
  25. 25.
    Maxwell J, Egan V, Chiswick A, Burns S, Gordon A, Kean D, Brettle RP, Pullen I (1991) HIV-1 associated cognitive/motor complex in an injecting drug user. AIDS Care 3:373–381Google Scholar
  26. 26.
    McArthur JC, Cohen BA, Selnes OA, Kunar AJ, Cooper K, McArthur JH, Soncy G, Cornblath DR, Chmiel JS, Wang MC, Starkey DC, Ginzburg H, Ostrow DG, Johnson RT, Phan JD, Polk BF (1989) Low prevalence of neurological and neuropsychological abnormalities in otherwise healthy HIV-1-infected individuals: results from the Multicenter AIDS Cohort Study. Ann Neurol 26:601–611Google Scholar
  27. 27.
    Miller EN, Selnes OA, McArthur JC, Satz P, Becker JT, Cohen BA, Sheridan K, Machado AM, Gorp WG van, Visscher B (1990) Neuropsychological performance in HIV-1-infected homosexual men: the multicenter AIDS cohort study (MACS). Neurology 40:197–203Google Scholar
  28. 28.
    Navia BA, Jordan BD, Price RW (1986) The AIDS dementia complex. I. Clinical features. Ann Neural 19:517–524Google Scholar
  29. 29.
    Nicolosi A, Leite MLC, Molinari S, Musicco M, Saracco A, Lazzarin A (1992) Incidence and prevalence trends of HIV infection in intravenous drug users attending treatment centers in Milan and Northern Italy, 1986–1990. J Acquir Immun Defic Syndr 5:365–372.Google Scholar
  30. 30.
    Portegies P, Gans J de, Lange JMA, Derix MMA, Speelman H, Bakker M, Danner SA, Goudsmit J (1989) Declining incidence of AIDS dementia complex after introduction of zidovudine treatment. BMJ 299:819–821Google Scholar
  31. 31.
    Poutiainen E, Elovaara I, Raininko R, Hokkanen L, Valle SL, Laehdevirta J, Iivanainen M (1993) Cognitive performance in HIV-1 infection: relationship to severity of disease and brain atrophy. Acta Neurol Scand 87:88–94Google Scholar
  32. 32.
    Pumarola-Sune T, Navia BA, Cordon-Cardo C, Cho ES, Price RW (1987) HIV antigen in the brains of patients with the AIDS dementia complex. Ann Neurol 21:490–496Google Scholar
  33. 33.
    Richter RW, Pearson J, Bruun B, Challenor YB, Brust JCM, Baden MM (1973) Neurological complications of addiction to heroin. Bull NY Acad Med 49:3–29Google Scholar
  34. 34.
    Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B (1987) Survival with the acquired immunodeficiency syndrome: experience with 5833 cases in New York City. N Engl J Med 21:1297–1302Google Scholar
  35. 35.
    Satz P, Morgenstern H, Miller EN, Selnes OA, McArthur JC, Cohen BA, Werch J, Becker JT, Jacobson L, D, Elia LF (1993) Low education as a possible risk factor for cognitive abnormalities in HIV-1: findings from the Multicenter AIDS Cohort Study (MACS). J Acquir Immun Defic Syndr 6:503–511Google Scholar
  36. 36.
    Schmitt FA, Bigley JW, McKinnis R, Logue PE, Evans RW, Drucker JL and the AZT collaborative working group (1988) Neuropsychological outcome of zidovudine (AZT) treatment of patients with AIDS and AIDS-related complex. N Engl J Med 319:1573–1578Google Scholar
  37. 37.
    Schoenbaum EE, Hartel D, Selwyn PA, Klein RS, Davenny K, Rogers M, Feiner L, Friedland G (1989) Risk factors for human immunodeficiency virus infection in intravenous drug users. N Engl J Med 321:874–879Google Scholar
  38. 38.
    Selnes OA, Miller E, McArthur J, Cordon B, Muñoz A, Sheridan K, Fox R, Soah AJ and the MACS (1990) HIV-1 infection: no evidence of cognitive decline during the asymptomatic stages. Neurology 40:204–208Google Scholar
  39. 39.
    Selnes OA, McArthur JC, Royal III W, Updike ML, Nance-Sproson T, Concha M, Gordon B, Solomon L, Vlahov D (1992) HIV-1 infection and intravenous drug use: longitudinal neuropsychological evaluation of asymptomatic subjects. Neurology 42:1924–1930Google Scholar
  40. 40.
    Stern Y, Marder K, Bell K, Chen J, Dooneief G, Goldstein S, Mindry D, Richards M, Sano M, Williams J (1991) Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. Arch Gen Psychiatry 48:131–138Google Scholar
  41. 41.
    Tross S, Price RW, Navia BA, Thaler HT, Gold J, Hirsch DA, Sidtis JJ (1988) Neuropsychological characterization of the AIDS dementia complex: a preliminary report. AIDS 2:81–88Google Scholar
  42. 42.
    Weber R, Ledergerber B, Opravil M, Siegenthaler W, Lüthy R (1990) Progression of HIV-infection in misusers of injected drugs who stop injecting or follow a programme of maintenance treatment with methadone. BMJ 301:1362–1365Google Scholar
  43. 43.
    Wilkie FL, Eisdorfer C, Morgan R, Loewenstein DA, Szapocznik J (1990) Cognition in early human immunodeficiency virus infection. Arch Neurol 47:433–440Google Scholar
  44. 44.
    Wilkins JW, Robertson KR, Horst C van der, Robertson WT, Fryer JG, Hall CD (1990) The importance of confounding factors in the evaluation of neuropsychological changes in patients infected with human immunodeficiency virus. J Acquir Immun Defic Syndr 3:938–942Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Hans-Jürgen von Giesen
    • 1
  • Harald Hefter
    • 1
  • Holger Roick
    • 1
  • Stefan Mauss
    • 2
  • Gabriele Arendt
    • 1
  1. 1.Department of NeurologyHeinrich Heine UniversityDüsseldorfGermany
  2. 2.Department of GastroenterologyHeinrich Heine UniversityDüsseldorfGermany

Personalised recommendations