HIV-associated dementia

This chapter reviews the use of antiretroviral therapy (ART) including its impact in altering the natural course of human immunodeficiency virus (HIV) disease; an overview of current regimens in use; factors influencing the choice of initial therapy; complications and adverse effects; and treatment failure, and resistance. The focus is on management of primary HIV-related diseases of the nervous system. While there is no specific therapy for HIV-associated dementia (HAD), both approved and developmental antiretroviral agents are discussed with a view to their effect on central nervous system (CNS) viral infection. Adverse drug effects that impact the nervous system are specifically discussed, as are pharmacological interactions between antiretroviral agents and other medications. The significance of cerebrospinal fluid (CSF) penetration by antiretroviral agents is reviewed. Adjunctive therapies, adherence to ART, treatment of comorbidities and coinfections that may worsen neurologic conditions are reviewed and include psychiatric illnesses and substance abuse. Lastly, non-pharmacological treatment strategies, education of patients and caregivers, graded assistance, behavior modification, and environment modifications are covered.