What is Aids-related cognitive impairment?

What is Aids-related cognitive impairment?

People with Aids sometimes develop cognitive impairment, particularly in the later stages of their illness. This information sheet explains how Aids-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. Aids-related cognitive impairment can be caused by:
The direct impact of HIV on the brain
Infections that take advantage of the weakened immune system.
How common is it?
It is difficult to be precise about the incidence of Aids-related cognitive impairment. Many of the studies into its incidence were carried out before the introduction of ‘combination therapy’ – the use of a combination of drugs to control HIV.
Symptoms
Symptoms of Aids-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.
Diagnosis
There can be problems diagnosing Aids-related cognitive impairment.
There has been some confusion about the precise definition of the condition.
Many people are misdiagnosed as having depression or other neurological or psychiatric conditions.
Sometimes, people develop the symptoms of dementia and are only later found to have the HIV virus. The following tests may be carried out:
HIV testThis blood test, which looks for the presence of antibodies to the HIV virus, should only be undertaken following specialist counselling.
CT scanA CT (computerised tomography) scan can be used to detect infections in the brain.
MRI scanMRI (magnetic resonance imaging) scans can show shrinkage of the brain tissue.
Lumbar punctureThis involves taking fluid from the base of the spine with a needle. It can be used to detect the amount of HIV infection in the fluid surrounding the brain.
Neuropsychometric testingThese psychological tests are used to measure the function of different parts of the brain.
Brain biopsyA brain biopsy 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.
Treatment
Anti-HIV drugsAt the moment it is not possible to cure 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 Aids.
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 Aids-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.
The success of these drugs has meant that the focus of treatment has now shifted from palliative care to rehabilitation.
Other medicationPsychiatric drugs are also prescribed to people with Aids-related cognitive impairment, including:
Antidepressants (such as fluroxetine, paroxetine, citalopram and venlafaxine). These are used to improve motivation and appetite.
Neuroleptics (such as olanzepine and risperidone). These can relieve agitation and anxiety.
RehabilitationA structured rehabilitation programme can help people with Aids-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.
Further information
Terrence Higgins TrustTerrence Higgins Trust is the leading HIV and Aids charity in the UK. Established in 1982, the Trust provides care services to people affected by HIV and Aids, as well as advice and information.
Terrence Higgins Trust52-54 Gray's