title: The neurobiology of HIV dementia: implications for practice in South Africa.
abstract: In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, South Africa. John.Joska@uct.ac.za
authors.forename: J A
authors.initials: JA
authors.lastname: Joska
authors.forename: J
authors.initials: J
authors.lastname: Hoare
authors.forename: D J
authors.initials: DJ
authors.lastname: Stein
authors.forename: A J
authors.initials: AJ
authors.lastname: Flisher
mesh_terms: D015526:AIDS Dementia Complex / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D023241:Antiretroviral Therapy, Highly Active; D058872:Epidemics; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load