Dear Doctors, I think I have a problem and I would appreciate your opinion on this. I am 31 years old, white HIV+ woman, time of infection uncertain (at least a couple of years), CD4-850, VL-3700. I have never been on the antiviral medication and am in a more or less good shape (mild neuropathy, frequent headaches, nothing too serious). What bothers me though is a new and rather strange experience with not being able to concentrate on simple actions like descending the stairs (I miss the steps), carrying more than three pieces, leaving the keys in a keyhole outside my house when I return home, and so forth. I constantly loose gloves, umbrellas, and other objects. I have never experienced anything of this kind before, it feels like as if my mind is shutting down on me from time to time. I am a professional woman, I travel and have to be 'with it' at all times. I am not stressed or overworked and can focus on my duties at work without any problem. However, it is becoming clear that I need to concentrate as much as I can on everything else I do. I am scared of not being able to function properly as I get a feeling my brain is playing tricks on me way too often. So, I guess the question is: what is it? Could it be serious? Shall I talk to my doctor about it sooner rather than later? Should I take any tests? It is getting to the point that I get way to stressed when I leave my house because I know I can loose my keys, forget to close the door, etc. Please advise what would be the best way to deal with it. Many thanks.

If these problems are truly not related to stress, then I suspect that your HIV disease has progressed and that your symptoms indicate HIV encephalopathy (also termed HIV dementia). I don't know what is deterring your from taking HIV medications, but in my opinion, now is probably the time to start. These symptoms usually respond beautifully to combination anti-HIV therapy. You asked about tests-- there are 2 different tests that can verify this diagnosis: one is a CAT or MRI scan of the brain, which may show some shrinkage of gray matter, and the other is a battery of neuropsychological tests that can explore memory, etc. But most of the time, the tests are unnecessary, because a working diagnosis can be made from your description of your problems and simple things that can be done by your doctor in the office. No matter how the diagnosis is made, the remedy is antiretrovirals. With your viral load and T cells, it should be easy for you to succeed with HIV therapy, and you could probably be treated with a simple regimen of 2-4 pills a day. See your doctor soon and get this resolved-- don't put it off. Good luck!