AIDS Dementia Complex: Diagnosis and Drug Treatment Options

Authors: Portegies P.; Rosenberg N.R.

Source: CNS Drugs, Volume 9, Number 1, January 1998 , pp. 31-40(10)

Publisher: Adis International

Abstract:

In the advanced stages of HIV infection, 15 to 20% of patients develop a progressive encephalopathy that has been termed ‘AIDS dementia complex’ (ADC) or ‘HIV dementia’. Clinically, this is a subcortical dementia that is characterised by slow mental functioning. Diagnosis is based on clinical features and exclusion (by the examination of CSF and neuroimaging studies) of other CNS complications.

ADC is not caused by an opportunistic infection of the brain, but is more directly related to the effects on the brain of HIV itself. The pathogenesis of the disease is only partly understood, but HIV replication in the CNS plays a key role. Therefore, antiretroviral therapy is the cornerstone of treatment for ADC.

Zidovudine penetrates into the CSF well compared with other drugs; however, most nucleoside reverse transcriptase inhibitors reach concentrations in CSF that are around or above their IC (concentration of drug required to inhibit viral replication by 50%). In contrast, protease inhibitors penetrate the blood-brain barrier poorly. The penetration of zidovudine into CSF is supported by clinical, pathological and CSF efficacy data. Knowledge concerning the tissue penetration of antiretrovirals is poor and the CSF pharmacokinetic and clinical data for most of them are limited. Further data on these parameters are urgently needed to develop strategies for combination therapies that have neuroprotective efficacy in patients with ADC.

Keywords: Reviews-on-treatment; Dementia, treatment; Neuroprotectants, therapeutic-use; HIV-infections, treatment; Zidovudine, therapeutic-use; Protease-inhibitors, therapeutic-use; Nucleoside-reverse-transcriptase-inhibitors,therap; Non-nucleoside-reverse-transcriptase-inhibitors, t; Antivirals, therapeutic-use; Acquired-immunodeficiency-syndrome; Dementia, diagnosis

Language: English

Document Type: Disease Management

Affiliations: 1: Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands *

Publication date: 1998-01-01

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• In this Subject: Pharmacology
• By this author: Portegies P. ;  Rosenberg N.R.

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