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Latest findings on cognitive impairment of undetectable HIV positive people?
Nov 28, 2011

Dear Dr. Fawcett,

My boyfriend is HIV positive for four years and undetectable for approximately the same time. His memory is, however, failing and he is only in his mid 30s. He has no recollection of some things I told him. He has trouble focusing. He has undergone testing but was told the tests had not picked anything up because they are meant for more drastic changes than the one he is experiencing. This doesn't make his experience less distressing. I understand that little is known on the link between HIV and CNS problems, but I would appreciate if you could point me to the latest and most interesting studies or resources on the matter. I'm not looking for general resources which basically state that we don't know or that level 4 penetrative ARVs are best but have most side effects. I'm interested in new findings or possibly even clinical trials which are being conducted into this matter.

Many thanks, A.

Response from Dr. Fawcett

Thanks for writing. As you know, combination antiretroviral therapies (CART) have reduced the incidence of cognitive impairment in both symptomatic and asymptomatic persons living with HIV. Despite this decrease, cognitive impairment remains a concern even when viral load is undetectable. Much work is being done to better understand this. I assume your boyfriend has been on antiretrovirals to maintain his undetectable viral load and that he had a neuropsychological workup. New research has identified certain medications as being more neurotoxic than others (abstract here). Studies have also identified variable symptoms at certain stages of infection pre and post CART (for example, here).

Since you seem comfortable with more technical information you may want to search Medline for other articles of interest. You can search clinical trials here.

Good luck to you and your boyfriend.

-David



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