AIDS Dementia Complex, or ADC, is one of the neurological conditions associated with AIDS and is an AIDS-defining illness. According to HIV InSite, there is a high morbidity rate associated with ADC, especially when severe. ADC impacts motor skills, cognition and sometimes behavior and is thought to be caused directly by HIV and not by an opportunistic infection.
HAART
According to HIV InSite, the primary method of treatment for ADC is the treatment of the underlying HIV with highly active antiretroviral therapy, or HAART. HAART is a drug treatment plan that combines medications--called antiretrovirals--that target HIV at different points of its cycle. In all conditions wherein HIV, instead of an infection that is taking advantage of the weakened immune state caused by HIV, is the primary cause of symptoms, treatment of the underlying condition is the best option.
BBB
The difficulty of treating ADC is that antiretrovirals must cross the blood-brain barrier, or BBB, a separation between blood and cerebrospinal fluid. According to HIV InSite, the antiretrovirals that accomplish this best are zidovudine, stavudine, abacavir, lamivudine, nevirapine, and indinavir. However, it has also been reported that sometimes patients improve due to antiretroviral treatments that are not known to cross the BBB well.
Considerations
Dr.Howard Crystal, of SUNY Downstate Medical College, notes that the psychiatric symptoms of ADC may respond to traditional treatments like antipsychotic drugs for delusions and hallucinations and selective serotonin reuptake inhibitors, or SSRI's, for depression and apathy. Crystal also notes that no single course of antiretroviral therapy has been shown to improve the symptoms of ADC.
New Treatments
David M. Simpson of the Clinical Neurophysiology Laboratories and the Neuro-AIDS program at Mount Sinai Medical Center, notes that new research is being engaged to find antiretrovirals that more effectively cross the BBB as well as to target secondary agents that may worsen the impact of ADC.
Prognosis
Crystal observes that HAART has extended life-expectancy for ADC patients far past the initial six-to-seven month morbidity before multidrug treatment. However, HIV InSite reports that six-month morbidity of ADC patients in one study remained at 67 percent and that morbidity increased with stage 2 or greater ADC.
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