HIV dementia

Dementia and milder forms of cognitive impairment are important manifestations, with important socioeconomic consequences, of HIV infection. Early detection and aggressive treatment are essential to achieve stabilization and prevent progression. In some affected individuals, reversal of symptoms may follow initiation of effective therapy. Antiretroviral treatment needs to be individualized, taking into consideration the relative central nervous system penetration of the drugs, presence of drug resistant viral strains, possible drug interactions, and drug side effect profiles. Combination antiretroviral therapy is preferred. Zidovudine, stavudine, abacavir, navirapine and indinavir have relatively good penetration into the central nervous system. The aim of therapy should be for control of viral load in the periphery and the cerebrospinal fluid. Furthermore, although not established therapy, the use of neuroprotective agents and anti-inflammatory regimens may be considered. A comprehensive multidisciplinary approach to management with regular follow-up is essential for treatment.