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The neurobiology of HIV dementia: implications for practice in South Africa Joska JA; Hoare J; Stein DJ; Flisher AJAfr J Psychiatry (Johannesbg) 2011[Mar]; 14 (1): 17-22In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.|AIDS Dementia Complex/drug therapy/epidemiology/*physiopathology/*prevention & control[MESH]|Antiretroviral Therapy, Highly Active[MESH]|Epidemics[MESH]|Humans[MESH]|Prevalence[MESH]|Risk Factors[MESH]|South Africa/epidemiology[MESH]|Viral Load[MESH] |
