Infraclinical neuropathies related to immunodeficiency virus infection associated with higher t-helper cell count

To assess subclinical involvement of the peripheral nervous system and its relationship to the immunological status of human immunodeficiency virus (HIV)-infected patients, we prospectively studied the peripheral nerve conductions and the subsets of peripheral blood lymphocytes of HIV patients. Fifty-seven patients, aged 20-54 years, 28 homosexuals and 29 heterosexuals, classified as CDC II—III (40 patients) and CDC IV (17 patients) were studied. No neurological symptoms or signs were present on bedside examination or questioning for all of the CDC II—III patients. For each conduction measured (H-reflex, sural and sciatic velocities, sural amplitude), the geometric mean was below normal values (p <0.05). Among the 57 HIV-infected patients, 20 (35%) had a significant decrease of at least one electrophysiologic measurement: 10/17 CDC IV patients vs. 10/40 CDC II—III patients (p <0.05). Two or more simultaneous abnormalities were more often observed in the CDC IV than in the CDC II-III group (9/10 vs. 4/10) (p <0.01). In the CDC II-III group, patients with subclinical neuropathies had higher T-helper and lower T-suppressor cell counts and higher T-helper/T-suppressor ratios than random patients without any neurologic abnormalities (1, 057 vs. 657 cells/µl, p <0.05, and 757 vs. 1, 304 cells/µl, p <0.01, 1.55 vs. 0.68, p <0.01, respectively). We conclude that (a) the peripheral nervous system is precociously and subclini-cally involved in the HIV disease; (b) the patients with infraclinical neuropathies have a significantly higher T-helper cell count than those without any neurologic involvement. The mechanism and the prognostic value of these two findings remain to be more precisely examined, and further studies are required.