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We studied one hundred and six neurologically asymptomatic HIV-1-seropositive patients, mostly drug abusers, in various stages of HIV-1 infection to evaluate the frequency of three primitive reflexes: snout, palmomental, and glabellar. We also examined one hundred HIV-1-seronegative drug abusers and one hundred healthy heterosexual individuals. We observed the presence of one or more primitive reflexes in 41% of HIV-1-seropositive subjects, in 8% of HIV-1-seronegative drug abusers and in 3% of healthy individuals. We elicited more than one primitive reflex in 22% of patients, but never among the subjects of the two control groups. The associations of multiple reflexes were significantly more frequent in the most severe CDC stages. Our observations suggest that including evaluation of primitive reflexes in a standard neurologic examination may be useful in screening for early non specific cerebral dysfunction in neurologically asymptomatic HIV-1-seropositive subjects.

An "in vivo" diagnosis of progressive multifocal leukoencephalopathy (PML), a neurological opportunistic viral infection in AIDS patients, can be made only by brain biopsy. In order to identify viral particles, we examined the cerebrospinal fluid (CSF) of 15 AIDS patients with focal neurological signs by electron microscopy using negative staining technique. In 2 out of 3 patients with clinical and neuroradiological presumptive diagnosis of PML, the CSF examination revealed papova-like viral particles. Our results support the hypothesis that the severe cell-mediated immunodeficiency reactivates papovavirus from a latent state in the brain, leading to PML. Therefore, the CSF study by negative staining might be a useful test for an "in vivo" diagnosis of PML.

Cerebral toxoplasmosis is the most common cause of focal CNS disease complicating AIDS and its incidence ranges from 3% to 40% of such patients. This opportunistic infection is generally due to reactivation of chronic toxoplasmosis as a consequence of severe immune deficiency. We present the clinical, neuroradiological and immunological findings of 15 AIDS patients with cerebral toxoplasmosis. All patients had focal neurological signs. CT-scan (13 cases) and NMR (2 cases) showed single or multiple mass lesions and edema. Serum IgG anti-Toxoplasma antibodies were positive in 14 patients; CSF specific IgG were positive in 5 out of 7 studied patients, while serum and CSF specific IgM were negative in all subjects. The intrathecal synthesis of anti-Toxoplasma antibodies were high in all 7 patients. A presumptive diagnosis of cerebral toxoplasmosis is based on the focal cerebral signs and neuroradiological findings. It is more frequently confirmed by the improvement of the clinical and neuroradiological picture during the treatment with pyrimethamine-sulphadiazine or clindamycin.