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Methodological Issues in the Assessment of Human Immunodeficiency Virus—Related Cognitive Impairment

Eric N. Miller, PhD; Paul Satz, PhD; Eric G. Bing, MD; Wilfred van Gorp, PhD; Hal Morgenstern, PhD; Barbara Visscher, MD, DrPH
Arch Gen Psychiatry. 1992;49(7):586-587. doi:10.1001/archpsyc.1992.01820070080017.
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To the Editor. —  Stern et al,1 in the February 1991 issue of the Archives, described a syndrome of neurologic and neuropsychological deficits that they believed to be associated with human immunodeficiency virus (HIV) infection. They reported that "HIV-positive men performed significantly worse on tests of memory, executive function, attention, and abstract reasoning.... even when only HIV-positive men who are completely medically asymptomatic are considered." We believe that this conclusion is premature on the basis of the results presented in their article.One potential source of bias in the article by Stern et al is the large number of men who reported that English was not their first language. In the medically asymptomatic HIV-positive group, 12 (24%) of the 49 subjects reported that English was not their first language, whereas in the HIV-negative control group, only two (2%) of 84 were nonnative English speakers. The percentages in the other


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