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Encephalopathy treatment?
Feb 14, 2005

I'm 48 yrs old and have been positive since 81 (by history) with no incidence of OIs. During the last 7 years I have been on three different cocktails. Recent testing shows that I am resistant to all NRTIs, however with Sustiva/Viread/Epivir combo I have been undetectable for a year now. I have recently been given a dx of encephalopathy following MRI and lumbar puncture ruling out other conditions. Since 97 I have not been able to raise my T-cell count above 100. As AZT has already been used, would you comment on possible combos of meds that might reduce the memory loss and inability to concentrate? My understanding is that Sustiva already penetrates the blood/brain barrier so would a change in meds be beneficial considering that my viral load has been undetectable? Thank you. Greg

Response from Dr. Horwath

The answer to your question is not clear. We do know that maintaining an undetectable viral load is the best predictor of non-progression of encephalopathy. People with high viral loads (especially with high CSF viral loads) are more likely to have progression of cognitive impairments. However, some people develop cognitive symptoms even on an effective HAART regimen.

There is no evidence that some regimens are better than others with respect to treating encephalopathy. Some of the ART drugs penetrate the blood-brain barrier more efficiently (eg. AZT, lamivudine, stavudine, nevirapine, indinavir) than others, but there is no good evidence to show that they are more effective at treating encephalopathy.



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