Dr. Perry Replies

SIR: Few systematic studies of drug users have examined psychological responses to HIV testing (1) or compared neuropsychological impairment in those who are and are not infected (2). Dr. Weddington and his colleagues are therefore to be commended for their efforts; however, the brief summary of their study does not help answer many relevant questions. Regarding the emotional impact of being notified about serological status, one wonders how the seropositive cocaine addicts became infected; whether they were equivalent to the seronegative addicts at entry in terms of psychiatric diagnosis, psychological status, current and past drug use, and HIV risk behaviors; whether the sample size was large enough at follow-up to detect psychological differences; whether the SCL-90-R alone is sensitive and specific to AIDS-related distress; whether relapse into drug taking was associated with notification; and whether the subjects were followed long enough for the findings to be clinically meaningful, considering the length of time the seropositive subjects will live with the knowledge of having a fatal illness. Regarding the absence of differences in neuropsychological impairment between seropositive and seronegative patients, the Cognitive Capacity Screening Examination is not sensitive to subtle cortical, and especially subcortical, deficits among CDC stage II patients (2).