Sunday, October 9, 2011

New info on HIV in the central nervous system

My first nursing job was on an HIV/AIDS unti in 1991. I seem to remember learning, in the early '90s, that we knew that co-infection with different HIV strains meant the person would get sicker quicker and be harder to treat (but trying to get HIV positive people to use condoms etc. with other HIV positive people was practically impossible in those days), and that people with these co-infections had much higher rates of dementia and a more aggressive disease generally.

This study -- finally, and despite the facile title -- gets more specific about what happens with HIV in the CSF (cerebrospinal fluid):

"Distinct AIDS viruses found in cerebrospinal fluid of people with HIV dementia"

By and large it's excellent work: the info on HIV in the macrophage is intriguing, as is the implied interplay between the seroactive HIV and the CSF-inhabiting HIV.

The implied determination to get more people on the horrifically aggressive HAART pharmaceutical regime is disappointing, for 2 important logical reasons:

1. This intensive regime, itself, has powerful and often irreversible effects on the following: mitochondrial survival, bone mineralization, memory & cognition, and digestion & absorption. That means teeth crumble and bones turn chalky, nutrition in food becomes unavailable so it's harder to maintain, and most of all, those of you who've read my work on mitochondria and on iatrogenic brain damage know how horrifying I find it to cavalierly trash those vital systems, most notably in the absence of any real efforts to support them in the face of iatrogenic -- let alone pathologic -- assaults.

2. The lack of any indication that the HAART drugs are any better at crossing the meninges (the covering over your spine & brain that forms the "blood-brain barrier") after this study, than they were before this study. That's an oversight that invokes a sardonic laugh. Heaven forbid the provider should actually pay attention to the patient and start the meds when needed, rather than assaulting the system maybe years before it's necessary in the hope of staying one month ahead of one strain's breakout. Bad math, you see?

It would be good to move away from the meme that drugs are the best, first, last, and finest answer. They're one part of it and they're easy to monitor, but we have to get a lot better at much more basic human care.

Good science. Stupid clinical take-away. But good science.

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