Despite the advent of drug cocktails that have markedly prolonged the lives of people with HIV-AIDS, one in four of these patients still suffer from significant neurological disorders, new Canadian research shows.
The study, published in the journal Neurology, identified 53 different brain-related conditions suffered by patients with HIV-AIDS, including severe nerve pain, seizures, dementia and stroke.
"Even with new treatments, this is not a benign chronic disease," Christopher Power, a professor of neurology at both the University of Alberta and the University of Calgary, said in an interview. "Neurological disease is a major cause of disability and death for people with HIV-AIDS," he said.
In fact, the rate of death is more than double in patients who have neurological problems compared with those who do not, the study revealed.
In 2003, Rita Tekeste was working at the Banff Springs Hotel when she suffered a stroke that left her right hand and leg paralyzed. She was only 27 years old.
In treating her, doctors discovered that she had HIV-AIDS. She had also contracted a parasitic disease that attacks the brain, toxoplasmosis, that triggered the stroke.
"I really thought I was going to die," Ms. Tekeste said in an interview.
She began taking antiretroviral drugs for the treatment of HIV-AIDS and largely recovered from the stroke, raising her two children and working as a counsellor for others with the disease.
But, in 2007, Ms. Tekeste started experiencing seizures and memory loss. She has not had any other HIV-AIDS related symptoms.
Dr. Power said her experience is fairly common.
"The virus in the nervous system is a little different from the virus in the blood," he said. In particular, drugs can have trouble crossing the blood-brain barrier.
Practically, that means that drug cocktails are not as effective at preventing neurological problems as they are at staving off other health woes associated with HIV-AIDS such as pneumonia.
Dr. Power said some HIV-AIDS medications also harm the brain. In particular, the older "d-drugs" such as ddI (didanosine), ddC (dideoxycytidine) and d4T (stavudine) can be neurotoxic, and the long-term impact of newer medications on the brain remain unknown.
There is also a growing belief that HIV somehow accelerates the aging process, particularly in the brain. "We're seeing diseases associated with aging like dementia in people with HIV," Dr. Power said.
The new research involved 1,651 patients with HIV-AIDS who were being treated at the Southern Alberta Clinic in Calgary from 1998 to 2008. Of that total, 404 patients, or 24.5 per cent, suffered from neurological problems.
The most common neurological problems were distal sensory polyneuropathy, a painful disease of the nerves in the hands, feet and bowel, and HIV-associated neurocognitive disorder, a mild form of dementia.
There are about 65,000 people living with HIV-AIDS in Canada and about 3,300 new infections annually.
André Picard