The NIH’s National Institute of Mental Health is funding a $60 million effort to find treatments to counteract HIV’s effects on the human brain. In the early years of the epidemic, AIDS dementia caused degeneration in some persons to the level of degeneration in patients with endstage Alzheimer disease; death typically followed within 6 months. With today’s treatments, the often unpredictable condition known as neuroAIDS is more subtle and appears 4 or more years before death. The memory loss this condition generates can cause patients to forget their medications and further exacerbate their condition. Experts speculate that if HIV patients live long enough, virtually all will experience some neuroAIDS symptoms (Neergaard L. Associated Press. October 2, 2006). The NIH-backed research is taking 2 approaches. The first is to determine which AIDS drugs give the best results for patients with memory loss. Ron Ellis of the University of California, San Diego, said that while some AIDS drugs—such as nevirapine(Drug information on nevirapine), abacavir(Drug information on abacavir), zidovudine(Drug information on zidovudine), and indinavir(Drug information on indinavir)—can cross the blood-brain barrier, it is not known whether they can slow brain damage after the onset of neuroAIDS. Next year, Ellis will lead a study in which 120 patients will be assigned either to a brain-penetrating combination or to other drugs. The second effort will seek to find drugs to protect nerve cells from inflammation-triggered toxicity. Two candidate treatments are the epilepsy drug valproic acid and the manic-depression drug lithium(Drug information on lithium). Both inhibit production of the enzyme GSK-3b. Too much of this naturally occurring substance can be poisonous, and HIV damages the brain by causing an imbalance in the enzyme’s production. Astudy by Harris Gelbard, a neurologist at the University of Rochester Medical Center, found indications that valproic acid might increase brain connections in neuroAIDS patients. In addition, Gelbard hopes to launch human studies of an experimental drug that targets a different inflammation- producing protein that HIV uses to make brain cells self-destruct. [CDC HIV/STD/TB Prevention News Update, Friday, October 6, 2006]
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