Dm. Simpson, Human immunodeficiency virus-associated dementia: Review of pathogenesis, prophylaxis, and treatment studies of zidovudine therapy, CLIN INF D, 29(1), 1999, pp. 19-34
Human immunodeficiency virus (HIV)-associated dementia (HIVD) has been repo
rted in up to 15% of HIV-infected adult patients. Although the pathogenesis
of HIVD remains unclear, HIV probably plays an important role in the syndr
ome, as evidenced by the correlation between cerebrospinal fluid (CSF) HIV
load and neuropsychological functioning. Although a large number of antiret
rovirals are used to treat HIVD, zidovudine is the best studied. Zidovudine
therapy has been associated with reduced levels of HIV RNA in CSF, fewer H
IV-related changes in brain tissue at autopsy, and time-limited improvement
s in neurological function among AIDS and HIVD patients. More recent studie
s have investigated the penetration into CSF of other antiretrovirals, incl
uding protease inhibitors, and the clinical efficacy of abacavir in the tre
atment of dementia, HIV encephalopathy may occur in 30%-60% of children wit
h AIDS and causes significant disability. Zidovudine has been associated wi
th improved neuropsychological functioning in children with progressive enc
ephalopathy, but optimum dosing levels, duration of effect, and prophylacti
c potential remain to be demonstrated.