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Unformatted text preview: Sensorimotor Dysfunction in HIV/AIDS: Effects of Antiretroviral Treatment and Comorbid Psychiatric Disorders Lance O. Bauer a , Natalie A. Ceballos a , John D. Shanley b and Leslie I. Wolfson c Objectives: Balance and gait problems have repeatedly been mentioned in case descriptions of patients infected with Human Immunodeficiency Virus (HIV-1). Objec- tive evidence of these problems has rarely been reported, however. Furthermore, the extent to which balance and gait are influenced by antiretroviral medications or comorbid psychiatric disorders has rarely been examined. Design: The study compared 78 HIV-1 seronegative volunteers to 28 HIV/AIDS patients receiving no antiretroviral therapy, 25 patients receiving only nucleoside analogue therapy, and 37 patients receiving Highly Active Antiretroviral Therapy (HAART). Methods: The dependent measures included Equilibrium Quotient scores recorded during 3 subtests of the Sensory Organization Test (SOT), the number of falls during each subtest, the functional base of support, gait speed and cadence, single leg balance time, proximal strength, and vibrotactile threshold of the foot. The analysis employed the number of alcohol and drug abuse problems, depression severity, and body mass index as covariates. Results: ANCOVAs revealed significant decrements in the 3 HIV-1 seropositive groups relative to the control group on Equilibrium Quotient scores during the most difficult of the SOT subtests (sway-referenced support surface with eyes-closed). HIV/AIDS patients also exhibited a smaller functional base of support and greater vibrotactile thresholds. Antiretroviral treatment did not affect balance; but, it did alter sensory threshold in a complex manner. Conclusions: HIV/AIDS is associated with reliable decrements in balance and periph- eral sensory function which are variably sensitive to antiretroviral treatment. The implications of these findings for mobility, and workplace or operator safety, should be contemplated. 2005 Lippincott Williams & Wilkins AIDS 2005, 19 : 495502 Keywords: musculoskeletal equilibrium, gait, sensory thresholds, sensory neuropathy, antiretroviral therapy, substance-related disorders Introduction HIV-1 may compromise balance or gait at multiple levels of the nervous system [1,2] with the potential for an additive effect and a pronounced mobility impairment. The factors which can independently or cumulatively contribute to balance and gait problems in HIV/AIDS patients include peripheral neuropathies , PML , muscle weakness , myalgia and fatigue , and cerebellar [10,11] and basal ganglia lesions [1,12]. Clinical evidence of balance or gait disturbance is reported in more than 57% of symptomatic HIV-1 seropositive patients and 25% of their asymptomatic peers From the Departments of a Psychiatry, b Medicine and c Neurology, University of Connecticut School of Medicine, Farmington, CT 06030-2103, USA....
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This note was uploaded on 11/12/2009 for the course PSY 3321 taught by Professor Ceballos during the Spring '09 term at Texas State.
- Spring '09