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Treatment against Cognitive Disorders
Feb 22, 2005

Dear dr.,

First, thanks for your good work; it helps. My question is on treating the cognitive problems that HIV causes. If I understand correctly, the chance of experiencing these problems declines because of anti-retroviral treatment but is still there; also, the progressive destruction of brain cells by HIV is not stopped entirely by the medication, due to the acids that macrophages etc. create in their battle against the remaining HIV viri. Then there is the decrease in dopamine-levels because of HIV.

The question is: do you think it is smart/possible to start treatment only three months after infection, because I feel I'm already experiencing memory-loss etc? The toxicity of medication has decreased and the range of medicins has increased; what could be the risk? Also: what do you think of using seligine (the Alzheimer anti-inflammation medicine)or dopamine-enhancing medication?

I am a student and my brain is one of the main sources of joy in my life; without my talents, I don't know whether I'd want to continue.

Thanks in advance,


Response from Dr. Pierone

The risk of developing AIDS dementia complex is much lower now and this is one of the major successes of antiretroviral therapy. Almost all of the clinically recognizable cases of AIDS dementia occur in people who have advanced disease and low CD4 counts. While cognitive deficits can sometimes be documented earlier in HIV infection with detailed neuro-cognitive testing, the significance of this observation is not clear. Some patients on Sustiva and Viramune also note neuro-cognitive problems from the medication, so there is not an easy solution to this issue.

Is it possible or smart to start therapy three months after infection? It is certainly possible, and many people choose to do exactly that despite the formal guidelines that recommend watchful waiting (it is a free country after all). Since we don't know if early therapy helps or hurts we are participating in the SMART study. In this trial, participants are randomized to either early treatment with HAART (any CD4 count) versus waiting until the CD4 drops below 250. But this would not be a study for you, since you are leaning towards early treatment.

I don't think that the risks of seligine and the dopamine enhancing medications make these a bad idea in your situation.

Hope this helps, best of luck to you!

Started Truvada & Sustiva
Pill count

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