What is HIV-Related Cognitive Impairment? from the Alzheimer's Society, U.K.

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What is HIV-related cognitive impairment?

People with HIV and AIDS sometimes develop cognitive impairment - particularly in the later stages of their illness. This factsheet explains how HIV-related cognitive impairment is diagnosed, and describes the symptoms and treatments available.

AIDS (acquired immune deficiency syndrome) is caused by the presence of the human immunodeficiency virus (HIV) in the body. HIV attacks the body's immune system, making the person affected more susceptible to infection. HIV-related cognitive impairment can be caused by:

* the direct impact of HIV on the brain
* infections (called 'opportunistic infections') that take advantage of the weakened immune system.

How common is HIV-related cognitive impairment?

It is difficult to be precise about the incidence of HIV-related cognitive impairment. As many as one in five people with HIV infection may have HIV-related cognitive impairment, but many doctors believe that the severity of HIV-related cognitive impairment is diminishing, as more people with HIV are taking medications.

What are the symptoms?

Symptoms of HIV-related cognitive impairment may include:

* forgetfulness
* concentration problems
* language difficulties
* problems with short-term memory
* clumsiness
* unsteadiness
* jerky eye movements
* ataxia ('drunken gait')
* changes in personality
* loss of appetite
* inappropriate emotional responses
* mood swings
* hallucinations.

How is it diagnosed?

There can be problems diagnosing HIV-related cognitive impairment. This is because there has been some confusion about the precise definition of the condition, and because many people are misdiagnosed as having depression or other neurological or psychiatric conditions instead.

Sometimes, people develop the symptoms of dementia and are only later found to have HIV. The following tests may be carried out:

* HIV testing − Initially, a blood test, which looks for the presence of antibodies to HIV, should be undertaken following appropriate counselling. This test is necessary to show that HIV is present in the body. Further blood tests to check the strength of the immune system (CD4 count) and to check the amount of HIV in the body (viral load) are then performed.
* CT scan − A CT (computerised tomography) scan can be used to detect infections in the brain. However, an MRI scan is better at doing this.
* MRI scan − An MRI (magnetic resonance imaging) scan can show changes in the brain caused by HIV, or opportunistic infections.
* Lumbar puncture − This involves taking fluid from the base of the spine with a needle. It can be used to detect opportunistic infections.
* Neuropsychometric testing − These psychological tests are used to measure the function of different parts of the brain.
* Brain biopsy − This involves taking a small piece of the brain and examining it in the laboratory. This procedure is not performed very often as it involves brain surgery.

How is it treated?

Anti-HIV drugs

At the moment, it is not possible to cure HIV or AIDS. However, the introduction of 'combination therapy' - the use of three or more anti-HIV drugs - has dramatically improved the life expectancy and quality of life of people with HIV or AIDS. Many patients can now expect to have a near-normal life expectancy.

The aim of these anti-HIV drugs is to decrease the amount of the virus in the bloodstream, reducing the damage that HIV can cause. People with HIV-related cognitive impairment are usually prescribed a combination of anti-HIV treatments to stop or slow down the ability of HIV to cross into the brain, and to reduce the amount of HIV causing damage inside the brain.

The success of these drugs has meant that the focus of treatment has now shifted from palliative care to rehabilitation. It is important that patients receive the correct treatment, as many cases of HIV-related cognitive impairment can be reversed if treated early.

Other medication

Psychiatric drugs may also be prescribed to people with HIV-related cognitive impairment, including:

* antidepressants (such as fluoxetine, paroxetine, citalopram and venlafaxine) which can be used to improve motivation and appetite
* neuroleptics (such as olanzepine and risperidone) which can relieve agitation and hallucinations.

For more information, See Factsheet 444, Depression and Factsheet 408, Dementia: drugs used to reduce behavioural symptoms.

Rehabilitation

A structured rehabilitation programme can help people with HIV-related cognitive impairment to relearn the skills they need to care for themselves. This might include relearning how to wash, dress and feed themselves, take medication, cook, and be aware of road and household safety.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Useful organisations

Alzheimer's Society

Devon House
58 St Katharine's Way
London E1W 1JX
T 020 7423 3500
0845 300 0336 (helpline open 8.30am-6.30pm weekdays)
E info@alzheimers.org.uk (general information)
helpline@alzheimers.org.uk (helpline)
W alzheimers.org.uk

The UK's leading care and research charity for people with dementia and those who care for them. The helpline provides information, support, guidance and referrals to other appropriate organisations.

Mildmay Hospital

Hackney Road
London E2 7NA
T 020 7613 6347
W http://www.mildmay.org/

Provides holistic inpatient and day care services for people affected by HIV cognitive impairment. Referrals must be made by other hospital or community services.

Terrence Higgins Trust

314-320 Gray's Inn Road
London WC1X 8DP
T 0845 1221 200 (helpline, 10am-10pm weekdays and 12pm-6pm weekends.
E info@tht.org.uk
W http://www.tht.org.uk/

The leading HIV and AIDS charity in the UK. It provides care services to people affected by HIV and AIDS, as well as advice and information.

Factsheet 446

Last updated: July 2008
Last reviewed: July 2008

Reviewed by: The HIV Brain Impairment Unit, Mildmay Hospital