n African Journal of Psychiatry - The neurobiology of HIV dementia : implications for practice in South Africa : review
|Article Title||The neurobiology of HIV dementia : implications for practice in South Africa : review|
|© Publisher:||In House Publications|
|Journal||African Journal of Psychiatry|
|Author||J.A. Joska, J. Hoare, D.J. Stein and A.J. Flisher|
|Publication Date||Mar 2011|
|Pages||17 - 22|
|Keyword(s)||Dementia, HAART, HIV, South Africa and University of Cape Town|
In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.
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