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Dementia
Dementia is now a very rare condition in people with HIV who have access to treatments. It has long been recognised that HIV can cause problems with memory and in the early years of the AIDS epidemic it was feared that as many as 40% of people with HIV would develop dementia. However, a large American study found that only about 7% of people with HIV developed the condition. This study was conducted before treatment with combinations of three or more anti-HIV drugs was available and dementia is now only seen in very rare and exceptional circumstances in the UK and other countries where people have access to anti-HIV drugs.
Symptoms
Remember that there can be many causes of mental health problems, ranging from depression through to dementia or infections, so it's important to see a doctor to find out the real cause of any problems you may experience.
The symptoms of HIV-1 associated dementia can be divided into three types, any or all of which may be present:
- 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 in the limbs.
Treatment
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 and 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.