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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Re: "Brain problems"
Jul 24, 2009

Hi Dr. Henry,

You wrote in response to a question entitled "Brain problems" that the "risk for significant neurocognitive problems with a suppressed plasma viral load and CD4 count > 500 is quite low but remains a concern with many unanswered questions."

I have followed this issue closely as my wife is HIV+, although I am fortunate to be HIV-. Her treatment response has been excellent so far (increase from ~226 CD4+ to 890 as of last count, after ~2 years of therapy). Her viral load is undetectable and always has been since within two months after starting treatment.

Question: when you say the risk of major neurocognitive problems is "quite low," are you able to assign a number to that risk? Are you aware of any studies showing the degree of risk in people with well-controlled HIV, similar to what I have just described?

Thank you very much for your work here. I read all the forums here frequently and almost always find something hopeful to take away with me.

Response from Dr. Henry

I find the literature on level of neurocognitive dysfunction for HIV+ persons doing well on HIV treatment (suppressed with CD4 count >> 350) to be confusing with no clear consensus= not possible to give a % of persons who are doing well and have clinically significant brain dysfunction. Sophisticated testing can often find a worrisome level of mild dysfunction but generally very low level of severe dysfunction. Certain HIV meds penetrate better in to brain but again the data is not clear as to whether better "brain" meds result in less mild dysfunction for patients doing well. This topic needs more work!! KH

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