HIV-Related Brain Deterioration: Identification, Symptoms, and Remedies
In the fight against HIV, one of the most challenging complications is HIV encephalopathy, also known as HIV-associated neurocognitive disorder (HAND), HIV-associated dementia, or AIDS dementia complex. This condition affects the brain and can lead to cognitive impairment, memory loss, and motor skill difficulties.
The Health Resources and Services Administration runs a program that provides medical care for people with HIV who have no or insufficient health insurance. For those diagnosed with HIV encephalopathy, the best course of action is to start or optimize antiretroviral therapy (ART) as soon as possible.
ART is the most effective treatment for HIV encephalopathy, helping to reverse some brain damage, improve cognitive test scores, and delay symptom onset. The current primary treatment involves initiating and optimizing ART to achieve effective viral suppression, particularly with regimens that have good central nervous system (CNS) penetration. This approach helps reduce viral replication in the brain, which is critical for managing cognitive impairment linked to HIV encephalopathy.
While there are no medications specifically approved to directly treat the cognitive symptoms of HIV encephalopathy beyond ART, strategies such as managing comorbidities like hypertension, diabetes, and depression, and preventing opportunistic CNS infections like toxoplasmosis, are crucial in overall neurological management in advanced HIV.
New ART drugs like lenacapavir, a twice-yearly injectable, show promise for HIV prevention and treatment with high efficacy and safety profiles, which could improve ART adherence and thereby indirectly benefit neurocognitive outcomes in HIV patients over time.
It is important to note that HIV encephalopathy is most likely to affect people who do not take effective HIV medications and those with a very low count of CD4 cells. Less than 5% of individuals who take antiretroviral therapy experience HIV encephalopathy. Factors that can negatively affect a person's outlook with HIV encephalopathy include increasing age, a lower CD4 cell count, decreasing platelet levels, and a lower body mass index.
For those living with HIV encephalopathy at home, strategies such as keeping the environment familiar, using memory prompts, and limiting the number of tasks that the person needs to perform at the same time can help. People with HIV encephalopathy may require a variety of medications, including opioids, anticonvulsants, antidepressants, and antiretroviral therapy, to manage different symptoms.
Communication can be challenging for people with HIV encephalopathy, so it is helpful for caregivers and family members to make eye contact before speaking and to speak slowly while maintaining a respectful tone of voice.
While antiretroviral therapy can help manage HIV encephalopathy and slow its progression, there is no cure for the condition. The Centers for Disease Control and Prevention (CDC) offers resources to help with a range of issues, including finding HIV medical care and mental health services in one's area.
- Beyond antiretroviral therapy (ART), managing comorbidities like hypertension, diabetes, and depression, and preventing opportunistic CNS infections are crucial for the neurological management of advanced HIV.
- The Health Resources and Services Administration provides medical care for people with HIV who have no or insufficient health insurance, making healthcare accessible for those in need.
- HIV encephalopathy, also known as HIV-associated neurocognitive disorder (HAND), can lead to cognitive impairment, memory loss, and motor skill difficulties, making daily tasks challenging for those affected.
- New ART drugs like lenacapavir, a twice-yearly injectable, show promise for HIV prevention and treatment, potentially improving adherence to treatment regimens and indirectly benefiting neurocognitive outcomes in HIV patients over time.
- Strategy for caregivers and family members of individuals with HIV encephalopathy includes making eye contact before speaking, speaking slowly, and using a respectful tone of voice, fostering better communication when face-to-face interactions become challenging.
