Jul 29, 2004
Dr. Horwath, I just read one of your previous responses that said only certain meds-penetrate the brain. The meds you listed i am resistant to. I am currently undectable but am experiencing cognitive slowing. Should I be on one of these drugs the penetrate the brain ever if I am resistant on genotype and phenotype tests to these meds. I am very nervous that I am declining mentally.
Response from Dr. Horwath
There is some evidence that some antiretroviral drugs penetrate into the central nervous system better than others. This has fueled a debate about which drugs are most appropriate for people experiencing cognitive slowing or other related symptoms.
This debate is certainly not resolved, but most studies on this subject (which are few in number) have shown that if a HAART regimen reduces the viral load to undetectable, then the chances of developing cognitive impairment due to HIV are very low. Your best bet is to to stay on a regimen that is effective in reducing your viral load. Switching to drugs to which your strain of virus is resistant is the wrong move. That would only cause your antiretroviral treatment to fail, which is not what you want.
If you're concerned about your cognitive functioning, you can seek testing from a qualified psychologist or other medical professional with experience in this area. Sometimes people have the impression that their thinking is impaired, but objective testing does not confirm this.
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