So: a year ago we learned that "the brains of HIV patients were 15 percent thinner in areas that control language, planning and movement. It didn't matter if the patients were on a drug regimen known as HAART..."

Then, six months later, in April of 2006, we found out that an AIDS treatment is linked to severe brain damage.

That April 2006 post actually links up with something we just learned and about which I posted: that a person can have a low viral load and still progress to frank AIDS.

Because that's what happened to the patient who had severe HIV-related brain damage.

His viral load was low.

But his brain was fatally damaged and he died.

Now, a year after that first report in HealthDay, we learn, in an article which appeared on Yahoo, that HIV in the brain "reduces patients' mental function by 25 percent."

Scientists test drugs for HIV dementia

By LAURAN NEERGAARD, AP Medical Writer

Mon Oct 2, 2006

WASHINGTON - It's an Achilles' heel of HIV therapy: The AIDS virus can sneak into the brain to cause dementia, despite today's best medicines.

Now scientists are beginning to test drugs that may protect against the memory loss and other symptoms of so-called neuroAIDS, which afflicts at least one in five people with HIV and is becoming more common as patients live longer.

With almost 1 million Americans, and almost 40 million people worldwide, living with HIV, that's a large and underrecognized toll.

"That means HIV is the commonest cause of cognitive dysfunction in young people worldwide," says Dr. Justin McArthur, vice chairman of neurology at Baltimore's Johns Hopkins University, who treats neuroAIDS. "There's no question it's a major public health issue."

While today's most powerful anti-HIV drugs do help by suppressing levels of the virus in blood -- so that there's less to continually bathe the brain -- they can't cure neuroAIDS. Why? HIV seeps into the brain very soon after someone is infected, and few anti-HIV drugs can penetrate the brain to chase it down.

"Despite the best efforts of (anti-HIV) therapy, brain is failing," says Dr. Harris Gelbard, a neurologist at the University of Rochester Medical Center. He is part of a major new effort funded by the National Institutes of Health to find the first brain-protecting treatments.

What's now called neuroAIDS is much different from the AIDS dementia of the epidemic's early years, when patients often had horrific brain symptoms similar to end-stage Alzheimer's, unable to move or talk. They'd die within six months.

Today, anti-HIV medication has resulted in a more subtle dementia that strikes four years or more before death: At first, patients forget phone numbers and their movements slow. They become less able to juggle multiple tasks.

Some worsen until they can't hold a job or perform other activities, but not everyone worsens -- and doctors can't predict who will. In a vicious cycle, the memory loss makes many forget their anti-HIV pills, so the virus rebounds.

Gelbard estimates that neuroAIDS reduces patients' mental function by 25 percent.

If HIV patients live long enough, many specialists worry, nearly all of them may suffer at least some brain symptoms.

"They're living longer with HIV in the brain," explains Kathy Kopnisky of the NIH's National Institute of Mental Health, which is spending about $60 million investigating neuroAIDS. "And they're aging, so they're going through the normal brain aging-related processes" that can make people vulnerable to Alzheimer's and other brain diseases.

...

[emphases mine]

Bill Weintraub:

One of the things we're hearing is that HIV does enormous damage before HAART can get to it.

For example, we're told in this article that "HIV seeps into the brain very soon after someone is infected, and few anti-HIV drugs can penetrate the brain to chase it down."

While Dr. Cohen told us a few weeks ago that in the first weeks of infection, HIV destroys all the T-cells in the gut, and that this is "terrible, irreversible, damage."

Dr. Cohen also told us that people are at their most infectious just after they've been infected -- that is, before the infection will show up on an antibody test.

It seems to me that this is important information.

Yet, as I've said, there's a widespread perception that HIV is "manageable."

Particularly in articles aimed at gay people, guys are told that if they get infected, don't worry about it, just get treated.

The reality is different.

As a newly-diagnosed man told the BBC in Living with HIV isn't easy:

"I had read the literature and it gives you an easy picture, but it is not completely like that."

"The literature" -- by which he means the stuff given out by the AIDS Service Organizations -- gives an easy picture.

The reality is different.

So: if we're serious about halting new HIV infections, we need to tell people the truth:

that even with HAART, HIV damages the brain.

And then you have "neuroAIDS."

Down in LA they've launched a huge campaign that says

"HIV is a gay disease."

Which isn't true.

Wouldn't it make more sense to put ads on billboards and in magazines and on the net which say "HIV damages your brain"?

Which is true.

In Uganda they found that a simple message about the deadliness of HIV worked:

In Uganda, HIV prevalence fell.

While in the rest of sub-Saharan Africa they relied on Western-style condom campaigns, designed for American and European gay men, and HIV prevalence soared.

Fact is, those condom campaigns have never been successful even among the men they were designed for.

Why?

Well, in my view, in part because they won't talk about death.

Instead, they rely on focus groups to develop the campaigns.

As though the choice between HIV infection and a full life was the same as the choice between Crest and Colgate.

It's not.

neuroAIDS: HIV damages your brain.

Bill Weintraub

© All material Copyright 2006 by Bill Weintraub. All rights reserved.