Evidence for a change in AIDS dementia complex in the era of highly active antiretroviral therapy and the possibility of new forms of AIDS dementia complex.
This review will discuss emerging evidence for the possibility that AIDS dementia complex (ADC) has changed in the era of highly active antiretroviral therapy (HAART). The consequences of not considering these possibilities at the patient level and at the level of research are considerable. Data will be discussed that are derived from epidemiological studies, neuropsychological and positron emission tomography studies, as well as analyses from the abacavir ADC trial. These will then be assessed to develop the concept that there are now different forms of ADC: an inactive form, a chronic variety and a 'transformed' variant. Whereas the latter relates to the compounding influence of a number of other processes on ADC, such as hepatitis C, particular discussion will focus upon Alzheimer's disease and whether HIV may lead to Alzheimer-like changes. It is certainly recognized that some of the concepts discussed here are highly speculative.
Brew
Bruce J
BJ
Department of Neurology, St Vincent's Hospital, Sydney, and National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, NSW 2010, Australia. b.brew@unsw.edu.au
D015526:AIDS Dementia Complex / Q000134:cerebrospinal fluid / Q000145:classification* / Q000150:complications; D000367:Age Factors; D000544:Alzheimer Disease / Q000150:complications; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D003072:Cognition Disorders / Q000150:complications; D015224:Dideoxynucleosides / Q000627:therapeutic use; D006801:Humans; D012367:RNA, Viral / Q000134:cerebrospinal fluid; D012720:Severity of Illness Index; D000099227:Abacavir
D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D012367:RNA, Viral; D000099227:Abacavir