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Sustiva & brain barrier
Aug 27, 2007

Dear Dr. In your opinion, does the fact that Sustiva seems to cross the barrier into the brain, which is my assumption based on Sustiva's side effect profile, mean it might help prevent the possible dementia effects described in recent research? I've been unable to find anything on the "net" that answers this question. If you don't know, I'd value your "gut" feelings on the subject. Many thanks to you!

Response from Dr. Wohl

There has been a lot of research trying to correlate HIV drug levels in the cerebral spinal fluid and prevention or treatment of dementia. To date, the results have been mixed and it is unclear that having a drug that gets into the brain really makes a huge difference when it comes to dementia associated with HIV.

That said, in such cases I do try to incorporate medications that can penetrate the blood-brain barrier when faced with a patient experiencing cognitive problems. Sustiva, funny enough, does not reach very high levels in the spinal fluid. There are a number of other drugs that seem to get in this space more readily.

Check out http://www.medscape.com/viewarticle/413262 for a response to a similar question by David Simpson, a wonderfully thoughtful HIV neurologist.

DW



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