Dementia

Before effective anti-HIV treatment (often called highly active antiretroviral therapy) became available, it was calculated that approximately 2 - 7% of people with very weak immune systems due to advanced HIV infection would develop dementia. Survival was, and remains, very poor for HIV-positive people with dementia.

Thanks to the success of anti-HIV treatment new cases of dementia are now very rarely seen, and these are only in people who have not been taking potent anti-HIV therapy.

The symptoms of dementia in HIV-positive people resemble those seen in older people with senile dementia and include:

• Difficulty in thinking or understanding, including forgetfulness, loss of memory, severe problems concentrating, confusion and problems planning and organising.
• Behavioural changes including feelings of isolation, a loss of interest, and childish behaviour.
• Problems with movement and coordination, such as loss of balance or strength from the limbs.

It is important to remember that there can be many other causes of the symptoms listed above, not only dementia. It is important to see your HIV doctor to find out what the cause is if you experience any of these symptoms.

Tests can assess subtle changes in memory, concentration, and the way the brain processes information. These can be as simple as an ability to memorise and recall lists. A sample of cerebrospinal fluid can also be checked to look for cell abnormalities and the presence of HIV. Scans can also help diagnose dementia.

Even before potent anti-HIV therapy became available in the late 1990s, the number of new cases of dementia seen in HIV-positive people was already falling.

Any potent anti-HIV therapy combination that keeps your CD4 cell count above 200 will protect you from developing dementia.

There has been some concern that older HIV-positive people – those aged 50 and above - may have an increased risk of mild brain impairment, involving symptoms such as forgetfulness. The evidence is far from conclusive, but untreated depression, fatigue, drug or alcohol abuse, and poor sleep patterns may be risk factors.

People with severe dementia often require special care. There used to be several special residential facilities providing care for HIV-positive people with dementia, but because the condition is now so rare these have largely closed. If round-the-clock care is needed this is likely to be provided either in a person’s home or a general residential care home. However, the Mildmay Hospice in London still provides specialist care for people with HIV-related dementia. HIV clinics can provide referrals.

Mania

Manic episodes – uncontrolled impulses, or bursts of energy or rage - are occasionally seen in people with very advanced HIV infection with very weak immune systems (a CD4 cell count below 50). It is thought that they were due to damage to the brain caused by HIV. Thanks to potent anti-HIV therapy cases are now extremely rare.