Newspaper article St Louis Post-Dispatch (MO)

Aids Dementia: The New Enemy Patients Are Living Longer, Giving Virus Time to Invade the Brain

Newspaper article St Louis Post-Dispatch (MO)

Aids Dementia: The New Enemy Patients Are Living Longer, Giving Virus Time to Invade the Brain

Article excerpt

A deadly enemy has emerged in the battle against AIDS.

It is called AIDS dementia, and it robs people of their memory, their energy and, finally, their lives.

Drugs are helping AIDS patients live longer, but they're also giving the AIDS virus more time to invade the brain.

In a few years, the number of people with the dementia will increase sharply and so will the cost of their care, experts say. They estimate:

The United States will have 10,000 to 20,000 new AIDS dementia cases each year.

Costs for each patient will be $40,000 to $80,000 a year.

"Clearly, the brain is a battered organ in people with AIDS," says Dr. David B. Clifford, a neurologist at Washington University.

Clifford has persuaded the federal government to give the first money - $1.5 million - for nationwide research on AIDS dementia. The research will be conducted by the Neurologic AIDS Research Consortium, a group of 16 medical centers. Clifford helped organize the consortium in 1993.

Clifford is chairman of the group, which includes Washington, Harvard, Yale and Johns Hopkins universities.

The consortium will soon do clinical trials of drugs to reduce AIDS' impact on the brain and nervous system. Human immunodeficiency virus, or HIV, which causes AIDS by destroying the immune system, has been found in the brains of nearly all patients who die from AIDS. About 20 percent of AIDS patients develop dementia.

Nationwide, more than 400,000 people have AIDS and 1 million more are infected with HIV. In 1994, nearly 5,600 Missouri residents had AIDS and 3,200 more tested positively for HIV.

The 1994 totals for Illinois weren't available; in 1993, Illinois had 11,145 cases of AIDS and 13,467 residents with positive HIV tests.

"For these patients, life eventually comes to a screeching halt," Clifford said in a recent interview. Before that happens, they may appear to be depressed. Some become psychotic.

"In the end, the dementia patients rarely move," he said. "They're incontinent and sit silently in chairs."


Rough Revelation

In the early 1980s, scientists focused on the many infections and rare cancers that were killing AIDS patients. HIV wasn't firmly linked to dementia until 1986.

By 1990, new treatments - particularly AZT - were extending AIDS patients' lives. But for thousands, living longer meant ending up with dementia.

Experts are cautious about diagnosing AIDS dementia. Potent drugs cause forgetfulness or slowed speech in many AIDS patients who don't have dementia. But over time, the signs are clear.

Clifford described a scientist, a genius at math games, who suddenly began losing to his children. In another month, the man could not read technical books.

"After awhile, he couldn't even get past the front page of a newspaper," said Clifford, 45. "It's a nasty illness."

The cause of AIDS dementia isn't known. The virus doesn't infect brain cells, such as the neurons. So researchers speculate that the cause is not nerve damage by HIV. Rather, it may be a toxic effect triggered by HIV infection.

Among the suspects are proteins called "cytokines," which can poison nerve cells. After HIV infection, the body makes a surplus of cytokines.

Another theory blames an increase of calcium in the brain. High levels of calcium can kill brain cells.

The discovery of AIDS dementia's cause is likely to shed light on how HIV damages other parts of the nervous system and other organs, Clifford said. …

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