Memory Loss in Persons With HIV/AIDS: Assessment and Strategies for Coping

Ola A. Selnes, PhD

Disclosures

AIDS Read. 2005;15(6):289-294. 

In This Article

Abstract and Introduction

Although the incidence of HIV-related dementia has decreased significantly in the era of contemporary HAART, the prevalence of memory and cognitive symptoms remains steady in persons with HIV/AIDS. Recognition of which memory symptoms may be specifically related to HIV infection is becoming more and more challenging because of the increased survival and aging of those living with HIV disease. Therefore, numerous age-related causes of memory impairment may need to be ruled out. Depression can often result in subjective memory symptoms but rarely causes objective cognitive impairment. Because of the widespread use of thiamine food supplementation, alcohol is now a less common cause of severe memory impairment. HAART remains the treatment of choice for HIV-related dementia.

Management of memory or of neurobehavioral symptoms may be complex and sometimes requires the participation of several medical specialties. Nonetheless, understanding the epidemiology and typology of the neurocognitive impairment associated with HIV infection can improve early diagnostic assessment, classification, treatment, and follow-up of HIV-infected patients with cognitive symptoms and possible dementia.

During the early years of the HIV epidemic, cognitive symptoms were thought to be common even during the initial, medically asymptomatic stages of the infection. Extensive research on the natural history of neurocognitive symptoms, however, soon established that cognitive symptoms or dementia specifically related to HIV infection occurred almost exclusively during advanced stages of the disease and in the setting of severe immunosuppression.[1]

With HAART, the incidence of HIV-associated dementia and cognitive impairment has been reduced significantly. Nevertheless, with patients living well into their 60s and 70s, the actual prevalence of mild to moderate cognitive impairment may be greater.

The aging of persons living with HIV disease has introduced several new issues in the workup of patients who present with cognitive symptoms. Because such comorbid conditions as hypertension, diabetes, and hypercholesterolemia become increasingly prevalent with age, it becomes important to distinguish between primary HIV-related cognitive symptoms and symptoms associated with age-related medical changes and disease. There is also evidence that the risk of diabetes among older HIV-infected persons is higher in the era of HAART, particularly in those who are coinfected with hepatitis C virus.[2]

In addition, the widespread use of HAART appears to have introduced subtle alterations in both the natural history and the time course of HIV-related cognitive impairment and dementia.[3] For example, in the pre-HAART era, the mean CD4+ cell count of patients with HIV-related dementia was typically below 100/µL. In current cohorts, the mean CD4+ cell count in this subpopulation has increased to above 150/µL, and survival time for patients with HIV-related dementia has increased dramatically, from approximately 6 months to 44 months.[4] Because of these changes in the natural history of HIV-related cognitive disorders, it is important to recognize subtle cognitive complaints early; this may significantly improve the probability of reversing an evolving HIV-related dementia syndrome with HAART.

Depending on its severity, neuro cognitive impairment may affect the quality of life in patients with HIV disease. Identifying this complication will permit the use of additional treatment to help patients compensate for deficits in functioning.[5]

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