October 16, 2002
Tests can often pinpoint difficulties that might not yet be obvious: subtle problems with memory, word retrieval, attention and the ability to follow complex directions. As the situation worsens, problems become obvious in everyday chores, missed appointments, lost work and forgotten names.
HIV infects monocytes, common blood cells that can move through the brain's protective membrane, triggering inflammation that changes brain cell physiology. HIV itself can also pass into the brain. Treatment can partially suppress HIV in the brain, said Dr. Gary Blick, who has tested dozens of medicines used in highly active antiretroviral therapy (HAART). But regimens can also come with side effects, including cognitive problems.
"It's hard to tease out what's going on," said Dr. Marshall Forstein, medical director of mental health and addiction services at Fenway Community Health. Doctors often overlook memory and thinking problems, or blame them on the stress of the illness. They could also be a signal for depression.
Examined at autopsy, HIV dementia's damage is to the basal ganglia, the same area affected in Parkinson's disease. Parkinson's destroys the cells; in AIDS dementia the problem is massive inflammation. Indeed, McArthur and colleagues have been testing the benefits of selegiline, a Parkinson's drug that blocks the inflammatory process.
Newsday (New York City)
10.15.02; Jamie Talan
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