Human immunodeficiency virus-associated dementia: Review of pathogenesis, prophylaxis, and treatment studies of zidovudine therapy

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.