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TG woman with cognitive problems
Mar 11, 2002

I an a MTF transsexual who was diagnosed with AIDS in 1993 and who began taking hormones in 1997. Over the past two years, I have developed increasing problems with dizziness, short-term memory, headaches, coordination, and ability to think clearly. The symptoms often worsen for a few hours or days and *partially* resolve.

After a particularly severe episode last fall, I went to the ER. A non-contrast head CT and an MRI (mostly non-contrast, except for contrast images of the pituitary and brain stem) revealed a "normal brain." A spinal tap performed as part of a clinical study found no evidence of immune activation in the CSF. Despite this, the episodes have continued to worsen. I am sometimes to dizzy to stand up and feel blood pounding in my head.

Unfortunately, I have received conflicting diagnoses: migraine, TIA, vertebral artery impingment from an MRI-diagnosed bulging disk in my neck, depression, and "have you though about your HIV?". Basically, each doctor attributes it to a specialty other than their own.

A drastic reduction in my hormones did not help. Treatment with antidepressents (serzone, wellbutrin, serzone + neurontin) only permanently worsened the problem. (I stopped taking them last fall.) I have been on delavirdine + crixivan + 3TC from 1996 to present, with a six month vacation in 2000. Except for my treatment interruption (due to nausea and fatigue, my viral load during this time has been undetectable below 50 copies and my CD4 count varied between 200 and 400. (Nadir CD4 71.) Other meds include estradiol valerate 40 mg q2w, testosterone enanthate 25 mg q2w (for muscle wasting), and 800 mg acyclovir tid for apthous ulcers and oral HSV-1.

Have you seen HIV-related dementia in people with undetectable viral load and a healthy lifestyle (good diet, no illict drugs)? Also, can a bulging disk actually interfere with blood supply to the brain? Could it be the meds or from the HSV-1 that keeps attacking my mouth and face?

Response from Dr. Feinberg

AIDS dementia is seen primarily in people with advanced disease that is not well-controlled. It is possible to have cognitive problems even when CT and MRI scans are negative, because there has to be enough shrinkage of brain matter ("atrophy") to be picked up by the scan. It is possible to have a battery of neuropsychological tests that can determine whether you have substantive neurologic problems or not.

It is possible to have bad enough disk disease to cause symptoms other than neck/back pain. This can sometimes respond to physical therapy; a more drastic measure is to have surgery for the bulging disk.

You don't say what kind of mouth/face problems you are having, but certainly herpes can cause lesions in these areas.

I don't think any of these problems is related to your transgender state or to your hormones.


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