In the '80s and '90s, when up to half of all people living with HIV developed debilitating brain disorders before effective antiretrovirals**, scientists at the time had little research on these issues. In fact, barriers to HIV/AIDS-related certification are common in our country, and more and more attention is being paid to them. Therefore, every person living with HIV should know a little bit about this, which can prevent the occurrence of certification barriers to a certain extent.
It's frustrating: HIV still affects people's brains even when viral levels remain undetectable. In many cases, the symptoms may be so mild that people won't notice. There is still a lot to be learned about HIV-related brain issues, such as:
How often do they occur?
Who is most vulnerable to them?
Do and how do they progress from minor problems to more serious ones?
What medications or interventions can slow or minimize them?
What neurological problems affect people living with HIV?
These are the directions of our further research.
Before the advent of effective **, HIV caused serious neurological disorders, including dementia. The terms "HIV-associated dementia" and "AIDS dementia syndrome" are often used. What's more, people with severely compromised immune systems are at risk of life-threatening brain infections, such as progressive multifocal leukoencephalopathy, toxoplasmosis, and cryptococcal meningitis.
Today, the umbrella term hand (HIV-associated neurological disorders) is used to describe a range of neurological problems related to thinking, memory, emotions, and sometimes even physical coordination and mobility. These symptoms include mild forgetfulness and difficulty concentrating, as well as more debilitating conditions such as dementia.
What causes HIV-related neurological disorders? How common is it?
Many factors contribute to brain problems in people living with HIV, including high viral load, low CD4 count, AIDS-related illnesses, persistent inflammation with AIDS medications, aging, depression, and other mental health issues.
HIV can enter the brain, and some studies have shown that this can happen up to two days after the virus first enters the body. HIV damages nerve cells in the brain, although researchers don't fully understand how this happens.
What's more, even antiretroviral** control of HIV infection can cause inflammation throughout the body. This damages cells and organs throughout the body, including immune cells that protect the brain, spinal cord and other parts of the nervous system.
HIV-related neurological disorders can occur on any CD4 count, but it occurs more often at levels below 200 because a weakened immune system makes the brain vulnerable to HIV and other organisms.
Studies have reported that the incidence of HIV-related neurological disorders among people living with HIV varies widely, ranging from around 15% to about half. One of the reasons for this discrepancy is that many people have mild symptoms that can only be detected by specialized tests. HIV-related neurological disorders are more common in older people, especially those with long-term HIV infection. People with HIV and hepatitis C co-infection, cardiovascular disease, and other comorbid health conditions appear to be at higher risk.
What are the symptoms of HIV-related neurological disorders?
HIV-related neurological disorders can have a range of symptoms, including changes in the ability to understand and process information (cognition), attention, memory, mood (mood), behavior, and the ability to move the body (coordination).
Some people have symptoms that are so subtle that they can only be detected through specialized neurological and neurocognitive testing. Others have mild symptoms, such as difficulty remembering names or difficulty concentrating. Still others have more severe and progressive symptoms, of which dementia is the most severe form.
It is normal for cognitive function and memory to decline as we age, which may not be related to HIV. It's unclear whether people with milder symptoms are more likely to develop severe dementia. As the HIV population ages, the picture is likely to become clearer as research deepens.
Symptoms of mild to moderate HIV-related neurological disorder may include:
Slow thinking. Brain fog (feeling "dizzy").
Difficulty concentrating.
Difficulty recalling facts, names, or new information.
It's hard to remember what happened in the past.
Having trouble learning a new task.
Sleep disturbances. The response is slower.
Impaired coordination.
Unsteady gait or difficulty balance.
Feelings of depression, anxiety, or irritability.
Confusion and disorientation.
Difficulty solving problems or handling complex tasks.
Inability to concentrate.
More severe memory loss.
Speech and communication difficulties.
Difficulties with vision and spatial abilities.
Insomnia. Difficulty standing or walking.
Muscle weakness. Loss of bladder control.
Mood changes, including mania, paranoia (excessive fear), or irritability.
Changes in personality and behavior.
Isolation and withdrawal from life.
Many of these symptoms can be caused by problems other than HIV-related neurological disorders, including excessive use of alcohol and drugs, clinical depression, and coexisting health conditions such as cardiovascular disease or hepatitis C. Some medications can cause some of these symptoms, including HIV medications, such as efavirenz. Older people living with HIV may develop dementia that is not related to HIV, such as Alzheimer's disease, and it can be difficult to distinguish between them.
If you experience these symptoms, especially if they get worse, tell your treating doctor. Given that the symptoms and possible causes are so widespread, it may take some time for you and your doctor to figure out exactly what's going on.
How are HIV-related neurological disorders diagnosed?
Before making a diagnosis of HIV-related neurological disorders, your doctor will try to rule out all other causes of your symptoms. If you're having trouble thinking, remembering, emotional, or coordinating, it's helpful to record those questions in a journal. HIV-related neurological disorder testing includes:
Mental status checks: This includes game-like tests to check cognition, short-term and long-term memory, and attention.
X-rays, CT scans, and MRIs: These tests provide images of the brain and spinal cord and can help specialists distinguish one type of problem from another.
Spinal tap (lumbar puncture): A needle is inserted into the spine to collect a small amount of cerebrospinal fluid – the fluid that surrounds the brain and spinal cord. Organism testing of fluids, including HIV that may be causing problems, can be done.
Can HIV-related neurological disorders be prevented?
It's unclear if or how HIV-related neurological disorders can be prevented, but there are a few things you can do to keep your brain sharp and improve your overall mental health.
Maintaining an undetectable viral load with HIV medications: Initiating and sticking to an effective antiretroviral** is the best way to prevent HIV-associated neurological disorders. Some HIV medications can cross the barrier that separates blood flow from the brain and spinal cord. Although it was once thought important to choose drugs that can cross the blood-brain barrier, modern antiretroviral drugs can control HIV throughout the body.
Other causes of managing neurological problems: Many conditions can directly or indirectly worsen brain function, including cardiovascular disease, high blood pressure, high blood sugar or blood lipid levels, and obesity, especially abdominal fat accumulation. Controlling cardiovascular disease helps ensure adequate blood flow to the brain. Two or three months of taking antiviral drugs is OK** for hepatitis C. Underlying conditions can reduce inflammation that causes brain problems.
Get Plenty of Exercise: Studies have shown that regular physical activity protects the brain. Experts generally recommend at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week. This can include daily activities such as dog walking and gardening.
Healthy eating: A healthy diet includes plenty of fruits, vegetables, and whole grains. Experts recommend limiting the consumption of red meat, processed foods, and unhealthy fats. Maintaining a healthy weight can improve your overall health and reduce inflammation.
Limit smoking, alcohol and recreational drug use: Quitting smoking can improve overall health, including brain health. Ask your provider for help quitting smoking. Limiting alcohol consumption — experts recommend no more than two drinks a day for men and no more than one a day for women — as well as recreational or street drug use can help avoid brain problems.
Stimulate your thinking: Studies have shown that lifelong learning can reduce the risk of dementia as you age. Exercising your mind — for example, doing puzzles, playing memory growth games, joining a book club, taking classes, or learning a new language — can help you keep your brain sharp.
Maintain social engagement: Social engagement not only prolongs life but also helps keep the brain in tip-top shape. This includes volunteering for a charity or political cause, joining a local exercise group, attending a religious service, attending a hobby club, or helping to save animals.
How to ** and manage HIV-related neurological disorders?
A variety of approaches can be used to improve HIV-related neurological disease symptoms and reduce their impact on quality of life. Early recognition and resolution of symptoms can lead to better outcomes, but may not be reversed in the later stages.
Optimizing HIV **Effective antiretroviral** is key to the control of HIV-associated neurological disorders. HIV** can control the virus and reduce inflammation. While modern antiretroviral drugs can control HIV throughout the body, switching to or adding HIV medications that more easily cross the blood-brain barrier may be an option for some people whose symptoms do not improve.
Learn strategies for coping with cognitive and memory problems: There are many techniques for solving poor memory or concentration problems. These include:
Keep a journal and write down what you want to remember or need to do. Also make a note of your symptoms so you can review them with your doctor.
Keep weekly and monthly checklists to help you remember important chores, regular errands, and bills that need to be paid.
Use a pill organizer to sort the medications. Fill the weekly pill box with the medication you need each week and place it where you can see it.
Write reminders on your phone or record voice memos to record things that are easy to forget. Did you take out the trash? Do you have a key when you leave the house? Place post-it notes where you're most likely to see them, such as on the bathroom mirror or front door.
Organize important items that you use regularly. Keep your wallet, keys and glasses in one place**.
Put labels on cabinets and drawers to remind you of what's in them.
People with HIV-related neurological disorders may experience problems with vision or coordination, making it difficult to walk in kitchens and bathrooms. Organize items into drawers and cabinets and label their contents. Remove the rug and don't leave clutter on the floor. Showers can be equipped with grab bars, seats and hand-held sprayers. Forgetting to turn off your oven can be dangerous, so install gas detectors and smoke alarms to alert you to a problem.
Seek cognitive or occupational: This is designed to help people relearn cognitive or physical skills that have been lost due to brain damage and learn new skills when old skills can't be relearned. Teachers also usually focus on practical skills for dealing with everyday tasks.
Consider other medications: While HIV medications can address the underlying causes of HIV-associated neurological disorders, they may not be effective** for their symptoms. Medications for some** related disorders include antidepressants and antipsychotics to control agitation and stabilize severe behavioral problems.
Summary:The diagnosis and treatment of HIV-related neurological diseases is complex, so what can we do as ordinary people to avoid neurological diseases?
1.Early detection of AIDS, early **, to avoid cranial nerve damage;
2.Strong antiviral drugs can be selected and drugs that damage the nervous system are avoided;
3.Pay more attention to your daily life, quit smoking, drinking, staying up late, drugs, etc.;
4.If there is cognitive impairment and psychological problems, seek help from a doctor in time;
5.Manage other medical conditions such as high blood pressure, diabetes, etc.
6.Use your brain more and actively participate in social activities.