- The Washington Times - Monday, October 2, 2006

ASSOCIATED PRESS

It’s an Achilles’ heel of HIV therapy: The AIDS virus can sneak into the brain to cause dementia, despite today’s best medicines.

Now scientists are beginning to test drugs that might protect against the memory loss and other symptoms of so-called neuroAIDS, which afflicts at least one in five persons with HIV and is becoming more common as patients live longer.

Almost 1 million Americans and about 40 million people worldwide live with HIV.

“That means HIV is the commonest cause of cognitive dysfunction in young people worldwide,” said Dr. Justin McArthur, vice chairman of neurology at Baltimore’s Johns Hopkins University, who treats neuroAIDS. “There’s no question it’s a major public health issue.”

While today’s most powerful anti-HIV drugs do help by suppressing levels of the virus in blood — so that there is less to continually bathe the brain — they can’t cure neuroAIDS. HIV seeps into the brain very soon after someone is infected, and few anti-HIV drugs can penetrate the brain to chase it down.

“Despite the best efforts of [anti-HIV] therapy, brain is failing,” said Dr. Harris Gelbard, a neurologist at the University of Rochester Medical Center. He is part of a major new effort funded by the National Institutes of Health to find the first brain-protecting treatments.

What’s now called neuroAIDS is much different from the AIDS dementia of the epidemic’s early years, when patients often had horrific brain symptoms similar to end-stage Alzheimer’s, unable to move or talk. They would die within six months.

Today, anti-HIV medication has resulted in a more subtle dementia that strikes four years or more before death: At first, patients forget phone numbers and their movements begin to slow. They become less able to handle multiple tasks.

Some worsen until they can’t hold a job or perform other activities, but not everyone worsens — and doctors can’t predict who will. In a vicious cycle, the memory loss makes many forget their anti-HIV pills, so the virus rebounds.

Dr. Gelbard estimates that neuroAIDS reduces patients’ mental function by 25 percent.

If HIV patients live long enough, many specialists worry, nearly all of them may suffer at least some brain symptoms.

“They’re living longer with HIV in the brain,” explained Kathy Kopnisky of the National Institute of Mental Health, which is spending about $60 million investigating neuroAIDS.

Biologically, this is a different type of dementia from any caused by Alzheimer’s or Parkinson’s, and drugs for those brain-degenerating diseases so far are proving disappointing against neuroAIDS.

The government-funded attack on neuroAIDS has two fronts:

• First, figure out which of the powerful anti-HIV cocktails are the best bet for HIV patients with memory problems.

A few of today’s HIV-suppressing drugs, such as nevirapine, abacavir, AZT and indinavir, can penetrate the blood-brain barrier, said Dr. Ron Ellis of the University of California at San Diego.

• Second, find drugs that protect nerve cells from the inflammation-triggered toxic chain reaction that seems to be how HIV wreaks its damage.

Topping the candidates are the epilepsy drug valproic acid and lithium, a drug long used in bipolar disorder.

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