HIV and the Brain: Unveiling the Hidden Threat of AIDS Dementia

HIV/AIDS impacts multiple organ systems, including the brain and nervous system. Most individuals are unaware that HIV spreads to the brain early in the illness process. HIV encephalopathy, a widespread brain infection, is one of the causes of dementia in HIV-infected patients. The severity of dementia symptoms increases with the spread of infection in the brain.

Dr. Praveen Gupta, Principal Director and Chief of Neurology, at Fortis Hospital explains why HIV encephalopathy, also referred to as AIDS dementia, is a significant HIV complication that typically manifests in the later stages of the disease.

According to Dr. Gupta, HIV-related neurocognitive problems are quite common among patients with HIV/AIDS. Reports indicate that the global prevalence of HIV-associated neurocognitive disorders (HAND) ranges between 7.3 per cent and 85 per cent.

He explains that HIV encephalopathy results from the spread of the virus to the brain, affecting brain volume and structure. This leads to memory and cognitive impairments, which can progress to dementia. Although the virus can reach the brain soon after infection, HIV encephalopathy usually occurs in advanced stages, making it an AIDS-defining illness.

Dr. Gupta says that the virus can evolve in the brain, becoming distinct from the HIV present in the blood. This evolution and compartmentalisation can render certain therapies less effective in the brain compared to other parts of the body.

While HIV encephalopathy cannot be cured, it can be delayed or controlled with antiretroviral therapy, says Dr. Gupta. Strict adherence to antiretroviral medication is critical after an HIV diagnosis to prevent progression to AIDS and reduce the risk of severe neurocognitive complications.

He adds that although HIV encephalopathy is less common now due to advancements in antiretroviral therapy, patients can still experience mild cognitive impairments, known as HIV-associated neurocognitive disorder (HAND).

Dr. Gupta outlines the symptoms of HIV-related dementia, which include memory loss, difficulty concentrating, impaired speech, a loss of interest in activities, declining motor coordination, and mood changes such as irritability.

He stresses the importance of early intervention, saying that without treatment, HIV-related dementia can become life-threatening within 3 to 6 months. As the condition progresses, emotional and physical challenges significantly impact the quality of life, requiring more support for daily activities.

Treatment, particularly with highly active antiretroviral therapy (HAART), can help slow disease progression and control symptoms for extended periods, says Dr. Gupta. HAART has significantly improved life expectancy for individuals with AIDS.

Dr. Gupta concludes by saying that the progression of HIV encephalopathy varies among individuals, depending on other AIDS-related complications and response to treatment. Consulting with a healthcare provider can provide a clearer understanding of the prognosis and management plan.

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