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Hiv encephalopathy
Nov 11, 2003

I am a long term surivior 12 years with Hiv. I have been diagonosed with HIV encephalopathy. In 91' my doc. put me 10 mg. of dexadrine per day to help with my slowed cognitve functioning. Other than azt-which i am resistant to and getting one's vl to undetectable-are there any promising treatments that improve cognitive functioning or is the damage permanent?please respond-i would like to improve my life.

Response from Dr. Horwath

HIV encephalopathy refers to the disease process that occurs in the brain as a result of the presence of HIV in the central nervous system. To the best of our current understanding, the virus stimulates an inflammatory process, which results in the release of various toxins that cause an impairment in some brain functions. This process worsens when the viral load is high.

There are several studies that have shown that neuropsychological performance improves with antiretroviral treatments that result in an undetectable viral load. Based upon these studies, the best treatment for HIV encephalopathy is an effective HAART regimen, which lowers the viral load to undetectable.

It is also known that some antiretroviral drugs penetrate into the central nervous system better than others. For example, AZT, lamivudine, nevirapine, and indinavir are among the drugs more effective at entering the central nervous system. It is not known if these drugs are more effective at treating HIV encephalopathy. More studies are needed to clarify this issue.

One thing that we do know is that the encephalopathy is not permanent. It is treatable, and people do improve in their mental functioning. In my own experience, I have seen patients improve dramatically even after having severe HIV-associated dementia with appropriate treatment.



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