A lot of us worry about losing our minds – particularly those of us who’ve had HIV for a while and are, how shall I put it, getting on in years? We remember the toll paid before decent HIV treatments came along. Early in the epidemic about one in seven people with AIDS developed dementia; a diagnosis that usually progressed to severe disability and death within a year.
But HIV-associated dementia is now so rare that the incidence is down to almost zero. What we are seeing these days, however, is quite a bit of low-level neurocognitve impairment. Some of it is so low level, in fact, that while it can be picked up by a range of neuropsychological tests, you and your significant others don’t even know anything is going on.
Up to 50 percent of people with HIV who are on treatment may be living with central nervous system (CNS) abnormalities. Most of these are mild and include things like peripheral neuropathy, myopathy (limb muscle weakness, myalgia and muscle cramps) and changes in brain structure and functioning.
HIV can get into the CNS quite early on, often within a week of infection. Over time it can cause an immune response, inflammation and production of chemicals (cytokines and chemokines). All this may result in damage to a range of cells, particularly in the brain.
For some people on treatment, HIV still seems able to affect those parts of the brain related to cognitive ability—including memory, learning, attention and how fast we process things. The problem is that these loses are similar to those we experience in older age. So, this intersection between ageing and HIV in the brain, together with a range of other factors, can make it difficult to untangle the relative contribution of each.
In the upcoming issue of Positive Living magazine, Neil McKellar-Stewart looks at HIV in the CNS and explains why taking treatment and a range of other health measures are so important for keeping our brains healthy. We list some of the commonly-used HIV treatments in Australia and rate them according to their ability to penetrate the blood-brain barrier.
We also tackle ways we can monitor our alcohol and drug intake. This is the time of year when many of us start to rev up our substance use; so Kurt Andersson-Noorgard suggests steps we can take to look at and then change our patterns of use.
And what is it like living with HIV in another country? David Menadue asked three people from culturally and linguistically diverse backgrounds about their journeys living with HIV and moving to Australia. Their stories are both touching and inspiring.