My neurologist tells me that I have an HIV infection in my brain, at a time when my viral load is undetectable (for more than a year) and CD is 200+. Iam presently on Ritonavir,Tipranavir, 3TC, Tenofovir and T20 and have in my time (it's 20 years since my diagnosis, never been hospitalised) taken just about everything else. There is evidence of diminishing brain function. He says we need to change my meds to more drugs that cross the brain barrier - I am taking only one such now. I have been told that my drug resistances fill many pages and that I can't expect any effect from past drugs.Is this true? I have a feeling I once heard that in some circumstances apparent resistance does not mean that the drug is necessarily useless. Could I expect that past drugs may have some utility in treating and/or controlling the brain infection?

Michael

Hi Michael, Thank you for your posting.

How HIV affects the brain and the impact different drugs can have on this is an area of active investigation. There does appear to be certain drugs that get into the brain better than other. In fact, there is concern that we might have people with considerable drug resistance who manage to get to undetectable levels of virus in their blood but not in their brain because the drugs being used don't penetrate well. Because of this concern it is reasonable to consider altering your therapy. That being said, based upon what you have written you have a lot of resistance and have managed to get to undetectable viral loads in your blood. If true, I would be reluctant to stop any of your current drugs. However, consideration could be given to adding drugs that do penetrate the nervous system such as AZT, abacavir, or both.

It is difficult to know whether there is resistant virus in your nervous system. Nevertheless, adding drugs that will hopefully be tolerable and penetrate the nervous system, regardless of your drug resistance history, may well be worth trying if your medical team thinks it would be appropriate. I would emphasize that you should not abandon your success in blood in attempts to better influence the brain, particularly if you can try to suppress both compartments of the body.

The situation you are in illustrates how complicated HIV medicine can be. It is very important at this stage that you work closely with your team of providers, the neurologist and your general HIV doc to move towards the best possible outcome.

Best, Eric