eMedicine Specialties > Neurology > Neurological Infections

HIV-1 Encephalopathy and AIDS Dementia Complex: Treatment & Medication

Author: Niranjan N Singh, MD, DNB, Fellow in Neurophysiology, Department of Neurology, St Louis University School of Medicine
Coauthor(s): Sofia Yahya, MD, Staff Physician, Department of Psychiatry, Barnes-Jewish Hospital, Washington University School of Medicine; Mandeep Garewal, MD, Staff Physician, Department of Neurology, Saint Louis University School of Medicine; Florian P Thomas, MD, MA, PhD, DrMed, Associate Chief of Staff, St Louis VA Medical Center; Associate Director, Neurology Residency Program; Professor, Departments of Neurology, Molecular Virology, and Molecular Microbiology and Immunology, Saint Louis University School of Medicine
Contributor Information and Disclosures

Updated: May 8, 2007

Treatment

Medical Care

Currently, HAART is the cornerstone of treatment for HIV-related cognitive disorders as defended by multiple randomized, placebo-controlled trials. Strategies for Management of Anti-Retroviral Therapy 2006 (SMART), a multicenter international trial and one of the largest HIV/AIDS treatment trials ever conducted, shows benefit of continuous treatment compared with episodic treatment. Case reports and small experimental studies have shown that stimulants and L-deprenyl may be helpful for attention and memory deficits. Research regarding n-methyl-D-aspartate (NMDA) antagonists, acetylcholine esterase inhibitors, antioxidants, and chemokine-receptor antagonists is in progress. At this time, no data support use of these latter interventions.

  • Metabolic causes of cognitive decline, such as other infections, vitamin deficiencies, thyroid dysfunction, and liver and renal dysfunction, should be corrected in consultation with internal medicine specialists.
  • HAART protects against, induces remission, and decreases incidence of ADC and HPE.
    • Early and continuous viral suppression with HAART is associated with improved performance on neuropsychological testing.
    • Antiretrovirals with good CSF penetration are the treatment of choice and include the following: lamivudine, stavudine, zidovudine, efavirenz, nevirapine, and indinavir.
    • When treatment fails and virologic rebound occurs, cognitive function deteriorates. Optimal doses in the presence of ADC remain unclear. If ADC develops during treatment with antiretroviral agents, additional or alternative agents should be tried.
  • Sometimes, depression and behavioral disturbances such as hallucinations or delusions require pharmacotherapy. However, caution is required when patients with ADC are treated with psychoactive drugs, such as antidepressants, antiepileptics, neuroleptics, and anxiolytics, because of enhanced susceptibility to sedative properties and possible paradoxical reactions. Such symptoms should be treated cooperatively by specialists in internal medicine, neurology, and psychiatry. Furthermore, physicians must remember that many drugs can upregulate the metabolism of HAART drugs, thus reducing its bioavailability.

Consultations

Care of patients with ADC and HPE is usually carried out in collaboration with primary care physicians and infectious disease specialists. Sometimes, neuropsychological testing and psychiatric consultation are helpful.

Diet

In general, patients with AIDS should be encouraged to maintain a balanced diet. Often this requires input from a nutritionist.

Activity

Patients should be encouraged to remain as active as their underlying disease permits.

More on HIV-1 Encephalopathy and AIDS Dementia Complex

Overview: HIV-1 Encephalopathy and AIDS Dementia Complex
Differential Diagnoses & Workup: HIV-1 Encephalopathy and AIDS Dementia Complex
Treatment & Medication: HIV-1 Encephalopathy and AIDS Dementia Complex
Follow-up: HIV-1 Encephalopathy and AIDS Dementia Complex
Multimedia: HIV-1 Encephalopathy and AIDS Dementia Complex
References
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References

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Further Reading

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Keywords

AIDS dementia complex, ADC, HIV-1–associated cognitive/motor complex, AIDS encephalopathy, HIV encephalopathy, subacute HIV encephalitis, HIV-associated dementia complex, AIDS-related dementia, HIV dementia, acquired immunodeficiency syndrome, AIDS, human immunodeficiency virus, HIV, minor cognitive motor disorder, MCMD, highly active antiretroviral therapy, HAART

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Contributor Information and Disclosures

Author

Niranjan N Singh, MD, DNB, Fellow in Neurophysiology, Department of Neurology, St Louis University School of Medicine
Niranjan N Singh, MD, DNB is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Coauthor(s)

Sofia Yahya, MD, Staff Physician, Department of Psychiatry, Barnes-Jewish Hospital, Washington University School of Medicine
Sofia Yahya, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Mandeep Garewal, MD, Staff Physician, Department of Neurology, Saint Louis University School of Medicine
Mandeep Garewal, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, and American Society of Neuroimaging
Disclosure: Nothing to disclose.

Florian P Thomas, MD, MA, PhD, DrMed, Associate Chief of Staff, St Louis VA Medical Center; Associate Director, Neurology Residency Program; Professor, Departments of Neurology, Molecular Virology, and Molecular Microbiology and Immunology, Saint Louis University School of Medicine
Florian P Thomas, MD, MA, PhD, DrMed is a member of the following medical societies: American Academy of Neurology and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Medical Editor

Michael J Schneck, MD, Associate Professor, Department of Neurology and Neurosurgery, Loyola University Chicago, Stritch School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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