Harris Gelbard was doing his residency in pediatric neurology in 1988 when one of his colleagues was diagnosed with AIDS. The man developed every neurological and psychiatric complication in the book: stroke, Parkinson's, paranoia. Then a gripping dementia left the 34-year-old doctor mute and in diapers. He died shortly thereafter.
Since then, Gelbard has spent his career studying how AIDS affects the brain, and he recently discovered what could be the first treatment for HIV dementia: valproic acid, used to treat epilepsy and bipolar disorder.
Although the current AIDS “cocktail” of drugs works to keep virus loads in the body low, the medicines have a hard time getting into the brain. Scientists know that the virus sneaks in early, within days or weeks of infiltrating the body, and then slowly destroys brain cells by attacking certain chemicals, such as glutamate, that are vital to neurons.
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Gelbard, a professor of neurology, pediatrics, microbiology and immunology at the University of Rochester, recently reported that valproic acid slows this dementia. The study involved 22 patients with HIV dementia, 16 people with memory problems and six unaffected subjects who served as controls. If larger studies bear out this initial finding, valproic acid would be the first drug for AIDS dementia, Gelbard says.
Mental symptoms most often reported by today's AIDS patients are more subtle than during the disease's early spread 20 years ago, when full-blown dementia developed in young people rather quickly. Patients now more typically complain of a host of murky neurological problems, including attention deficits, slowed thoughts and problems focusing on daily tasks. “You are 80 percent of yourself,” Gelbard explains. As more people survive with the current AIDS cocktail, as many as 20 percent are left with these problems, he says.
