HIV-related mental disorders

It is estimated that before HIV treatments became widely used, 7% of people with advanced HIV infection would develop dementia. Mania has also been observed in people with advanced HIV disease. It is highly unusual for a person who has been treated with anti-HIV drugs to develop either of these conditions as a direct result of being HIV-positive.

Symptoms of dementia include:

• Difficulty in thinking or understanding, such as forgetfulness, loss of memory, loss of concentration and confusion.

• Changes in behaviour, including loss of interest, feelings of isolation and childishness.

• Problems with movement and co-ordination, such as loss of balance or strength from the limbs.

There can be many causes of the symptoms listed above, including depression and infections, as well as dementia. So, it’s very important to see your doctor to find out what the real cause is.

Some anti-HIV drugs appear to offer protection against the development of dementia. The first anti-HIV drug seen to help prevent dementia developing and as a treatment for the condition was AZT (zidovudine, Retrovir). More recently, d4T (stavudine, Zerit) and abacavir (Ziagen) have also been shown to offer protection against dementia and to help prevent the condition. A study has also suggested that combinations containing efavirenz (Sustiva) may be effective.

The reason why only some of the currently available anti-HIV drugs work against dementia is because the brain and spine are separated from the blood by the blood-brain barrier, which only allows very small molecules to get into the central nervous system. AZT, d4T, abacavir and efavirenz's effects on dementia are thought to be due to their ability to cross the blood-brain barrier, achieve effective levels and fight HIV in the brain. Some researchers argue that any anti-HIV regimen that significantly improves the immune system should also improve dementia, as immune cells can cross the blood-brain barrier.