AIDS dementia complex

January 2007     View PDF     En español

Treating ADC

The best therapies to treat ADC appear to be anti-HIV drugs, and high-dose AZT is the most studied drug for it. However, many specialists contend that how well a potent regimen controls HIV reproduction overall is more important than the actual drugs used in the regimen. This may or may not include using standard, or even high-dose, AZT as part of the regimen.

Generally speaking, creating an anti-HIV regimen with the extra goal of treating ADC follows three basic principals:

• Start a potent regimen (usually 3 drugs) to decrease HIV levels to below the limit of detection of viral load tests;
• In people who have used anti-HIV therapy before, consider the prior therapy history as well as information from anti-HIV resistance tests;
• If possible, use anti-HIV drugs that cross the blood-brain barrier as part of a combination therapy regimen.

It’s believed—based on findings that high-dose AZT (1,000–1,200mg/daily) can cross the blood-brain barrier and effectively treat ADC—that an anti-HIV drug that crosses the blood-brain barrier might help prevent or treat ADC. To date, AZT is the best understood treatment available for ADC. Several groups have reported improvements in cognitive functions with AZT as well as prevention of HIV infection of the brain. Larger doses (1,000mg compared to the now-standard 600mg per day) of AZT appear to be necessary for treating ADC. However, high-dose AZT may present problems since many people with HIV, particularly those who are the sickest, are often unable to tolerate its side effects.

While AZT may be the most researched drug for treating ADC, other anti-HIV drugs that cross the blood-brain barrier may be equally useful. These include—in addition to AZT—d4T, abacavir, nevirapine, amprenavir, atazanavir and to a lesser degree indinavir and 3TC. Efavirenz has not been shown to cross this barrier to a significant degree, but some experts speculate that it may be useful in treating ADC.

Anti-HIV therapies are best used in combinations. It may also be important to consider a drug’s ability to cross into the brain when constructing an effective regimen. For information on developing long-term strategies and creating potent anti-HIV therapy regimen, call Project Inform’s Hotline at 1-800-822-7422 or email a question.