Evidence-Based Treatment for HIV-Associated Dementia and Cognitive Impairment: Why So Little

Ronald J Ellis

doi:10.1371/journal.pctr.0020015

Abstract

Evidence-Based Treatment for HIV-Associated Dementia and Cognitive Impairment: Why So Little

Highlights

HIV-associated dementia (HAD) and milder forms of cognitive impairment produce a spectrum of disability that ranges from complete inability to care for oneself to reduced work efficiency and quality of life
Double-blind, placebo-controlled trial, 105 HIV-positive patients with HAD who were already receiving combination antiretroviral regimens (‘‘stable background therapy’’ [SBG]) for at least eight weeks were randomized to treatment with abacavir or placebo for 12 weeks, in addition to their existing regimen
Referred to as ‘‘optimal’’ background therapy, participants’ regimens at trial entry were for the most part failing, with virologic success having been achieved in only 23% of individuals in the abacavir arm, and 9% of individuals in the placebo arm. This lack of virologic efficacy of SBG may have reflected a variety of contributing factors, including drug resistance, poor adherence to antiretroviral therapy (ART) resulting from cognitive impairment, and the relative inexperience of practitioners at that time in applying combination regimens

Summary

Introduction

HIV-associated dementia (HAD) and milder forms of cognitive impairment produce a spectrum of disability that ranges from complete inability to care for oneself to reduced work efficiency and quality of life. In the years between completion and publication of the trial, knowledge about the impact of antiretroviral therapy on cognitive impairment in HIV continued to accumulate. New cases of severe dementia became less frequent [8,9], and there was clear evidence of improved cognitive function, even in those with mild impairment [10].

Results

Conclusion