Management of neurobehavioral impairment in HIV-1 infection

HIV dementing illness recently has been delineated into two categories, HIV-associated minor cognitive/motor disorder that may or may not progress to an actual dementia, and HIV-associated dementia complex. At this time, these disorders are distinguished by severity of impairment. As such, each disorder presents with different management problems and thus requires different types of interventions. A model of patient management has been presented herein for each disorder, enumerating possible management problems and practical strategies to address them. Health care providers, in their role as consultants, can educate patients and caregivers about patient management, thus improving quality of life for all involved. The presented paradigm for patient management is based on current knowledge of HIV dementing illness and thus is clearly lacking. Critical issues still exist, in regards to the characterization of the behavioral and cognitive changes associated with HIV infection. The course of this neuropsychiatric illness remains poorly defined, and the progressivity of this illness, while at times is quite certain, is not always so certain. What differentiates those who progress to an end-stage dementia versus those who stop short is unclear. Additional neuropsychiatric research obviously needs to be done, but for individuals with HIV-related neurologic disorders, practical issues are pressing. Specialized residential programs need to be implemented and additional medical and financial services need to be more readily available. Health care providers can serve a crucial role here in making these needs known and actively promoting change in the current health care system.