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Organic Dementia

Jan 20, 2005

My partner and I have been diagnosed HIV + since 1993 and up to last year we were healthy. However, he started having severe issues with memory and after hospitalization in a mental hospital for a week and a long journey through social services since he doesn't have health insurance, he was able to get seen by a neurologist who at first made a diagnosis of vascular organic dementia probably caused by his HIV or syphillis. A later test - MRI & spinal tap - confirmed that it wasn't associated with syphillis, so he believes his dementia is associated with his HIV infection. Since May 2005 he's had psychotic episodes was seen by a psychiatrist who started him on geodon, lamictal. Neurologist has prescribed namenda for memory and depakote. His PCP has him on videx, crixivan, viread, norvir, and ziagen and his viral load hovers around 250. He hasn't been able to work since memory is so basic to everying one does; he doesn't recall our last 15 years together - how he got to where he is and if he even lives where he has been living for the last five years. It seems as there is no support or communication between the three physicians except from the information I bring to the appointments.

I've dealt with a grandmother living with Alzheimers for 10 years and sometimes I see this heading in that direction. Does all the medications he is taking help him at all - does he need a change if there is no improvement? Does the medication complicate his body chemistry even more?

Response from Dr. Horwath

Dementia is a known complication of HIV infection. It tends to occur late in the course of HIV infection, and is usually associated with high viral loads and low CD4 counts seen in people who are not taking HAART or who are on a failing HAART regimen. Your partner is a bit unusual because of the severity of his illness in the presence of a fairly low viral load. However, the diagnosis by the neurologist is consistent with your description and with the test that you mentioned.

I agree with you that the physicians should have some communication with each other.

Yes, he is taking a lot of medications, but from the severity of his symptoms, it sounds like he does need them, especially if he has improved due to the medicines. I don't know in which direction he is headed. HIV-associated dementia is different from Alzheimer's disease. People with HIV-associated dementia can recover even from a fairly severe dementia if they respond to on an effective HAART regimen. You have reason to remain hopeful. The main challenge is to find a HAART regimen that can effectively control the virus.


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