Document 0836
 DOCN  M95A0836
 TI    Review of antiretroviral therapy in the prevention of HIV-related AIDS
       dementia complex (ADC).
 DT    9510
 AU    Portegies P; Academic Medical Centre, University of Amsterdam, The;
       Netherlands.
 SO    Drugs. 1995;49 Suppl 1:25-31; discussion 38-40. Unique Identifier :
       AIDSLINE MED/95339780
 AB    Following the introduction of zidovudine, a major decline was noted in
       the incidence of AIDS dementia complex (ADC). Several factors point to a
       causal relationship. It is important now to review the evidence derived
       from clinical, cerebrospinal fluid (CSF) and neuropathological studies
       to determine whether the protective effect of zidovudine on the brain of
       patients with HIV infection has implications for clinical practice. It
       has been demonstrated in clinical studies that patients with ADC may
       improve with zidovudine treatment and that the development of ADC is
       rare in patients receiving the nucleoside analogue long term. In support
       of these clinical findings, CSF studies have revealed that the presence
       of HIV-1 p24 antigen has diagnostic value in patients with suspected ADC
       and that p24 antigen levels decline with zidovudine treatment.
       Supporting evidence has also come from neuropathological studies, which
       have demonstrated that zidovudine decreases HIV-specific
       neuropathological abnormalities. Recently, the Multicenter AIDS Cohort
       Study reported conflicting data which suggested that antiretroviral
       therapy is not protective against ADC; however, several methodological
       weaknesses of this study limit the general applicability of the findings
       and the conclusions. In view of the increasing body of evidence in
       support of the efficacy of zidovudine in the prevention and management
       of ADC in patients with HIV-1 infection, it seems reasonable to include
       this antiretroviral agent in any combination treatment regimen. Many
       questions remain to be answered, however, before management of such
       patients is optimised. Meanwhile, in order to increase both insight and
       evidence, it is imperative that ongoing and future clinical trials with
       antiretroviral drugs closely monitor all cases of progression to
       ADC.(ABSTRACT TRUNCATED AT 250 WORDS)
 DE    AIDS Dementia Complex/CEREBROSPINAL FLUID/IMMUNOLOGY/*PREVENTION  &
       CONTROL  Human  HIV Core Protein p24/CEREBROSPINAL FLUID  Incidence
       Zidovudine/*THERAPEUTIC USE  JOURNAL ARTICLE  REVIEW  REVIEW, MULTICASE

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