HIV-1 Specific Immune Responses in Thai Individuals With HIV Dementia

A total of 60 participants will be enrolled. They will be in 3 groups

1. ARV-naïve, HIV-positive ≥ 20 year of age with HAD (n=25) who intend to start ARV
2. ARV-naïve, HIV-positive ≥ 20 year of age without HAD (n=25), who intend to start ARV
3. HIV-negative ≥ 20 year of age (n=10). The protocol team will work with the primary care physician to ensure that the subjects receive standard HIV and ARV care; however, initiation of ARV is not a requirement of the study and ARV will not be provided by the study.

Inclusion Criteria:

Group Thai HAD individuals

• 20 years of age

  • not currently receiving nor have ever received antiretroviral medications
  • not explained by opportunistic infections or causes other than HIV on the basis of clinical assessment and neuropsychological testing and eligible for inclusion.

Group Thai Non-HAD individuals

• will be matched with a seropositive Thai patient with similar age (same decade), education (less than high school degree, high school degree +/- some college, college degree +), gender, and CD4 group
• HIV positive
• not currently receiving nor have ever received antiretroviral medications.

Group Thai Non-HAD individuals will be matched with a Thai seronegative patient by age (same decade), and education (less than high school degree, high school degree +/- some college, college degree+), and gender.

Exclusion Criteria:

• Head injury with loss of consciousness greater than 1 hour
• Current or past illicit drug use (less then 5 years) or positive drug screen for amphetamine, methamphetamines, cocaine, marijuana, or narcotics at either screening or entry.
• Inability to provide informed consent or lack of designated surrogate who can provide consent
• The following laboratory values:
• PT/PTT > the upper limit of normal (ULN) or INR > 1.1
• Hemoglobin < 9.0 mg/dL
• ALT > 5x ULN
• serum creatinine > 2x ULN or creatinine clearance < 30 cc per min by Cockroft-Gault formula
• Acute illness within 30 days prior to entry, persistent and active AIDS- defining opportunistic infection or autoimmune disease. Stable treated opportunistic infections on maintenance therapy, minor infections such as oral thrush and Kaposi's Sarcoma limited to the skin will be allowed.
• Current or recent fevers or meningeal signs suggestive of CNS opportunistic infection.*
• History of pre-existing neurologic disease to include stroke, multiple sclerosis
• History of psychiatric illness including schizophrenia, bipolar disorder, anxiety disorder, panic attacks, or post traumatic stress disorder. Patients with active major depression will be excluded as well - patients with past depression that is controlled and patients with or minor depressive symptoms will be allowed to enroll.
• Known learning disability including dyslexia.
• Positive Hepatitis C serology (Hepatitic C Ab)
• Confusion or other signs and symptoms of metabolic encephalopathy or delirium
• Mass consistent with opportunistic infection or tumor on CT or MRI of the head, or focal neurological deficit on examination consistent with possible brain lesion.*
• Other conditions that could explain neurocognitive decline in the opinion of the investigator such as hypothyroidism, vitamin B12 deficiency or neurosyphilis.
• Pregnancy.
• Not willing to take an MRI.