Jessica Robinson-Papp, MD, MS, professor of neurology at the Icahn School of Medicine at Mount Sinai, talks about the strides made in antiretroviral therapy for HIV and how these improvements lead to better patient outcomes.
Clinical guidelines highlight the importance of medication adherence and early treatment of HIV, and this can help with potential neurological complications; newer antiretrovirals are also easier to tolerate, says Jessica Robinson-Papp, MD, MS, professor of neurology at the Icahn School of Medicine at Mount Sinai.
How can neurologic complications be prevented in patients with HIV, and how can we ensure patients are taking these steps?
The most important thing is medication adherence and early medication and early treatment of HIV, which is what the clinical guidelines are now. The guidelines that we follow is that when someone is first diagnosed positive, then they should go on treatment and they should stay on treatment. That will help with the neurologic complications as well, and of course when we move toward trying to find cures for HIV that should hopefully help even more.
Some of what we see is a bit of a legacy effect, because some of our older patients are also the same patients who were infected over very long periods of time and are also the same patients who were infected very early in the epidemic. Those people probably experienced more immunosuppression because there wasn't treatment at the beginning and then they also experienced some of the suboptimal therapies that were there in the very beginning that had more toxicity.
A lot of our older antiretrovirals had significant neurotoxicity; they don't anymore. So, we're hopeful that patients who are infected later and people who are being infected now won't have as many neurologic complications to begin with because the care will be started sooner and will be more effective and easier to tolerate.