STUDY RATIONALE: To date, over 16 million people in Africa have died of AIDS and approximately 26.6 million or almost 70% of the world''''s total of HIV-infected people reside in Sub-Saharan Africa. Given that 40 million people globally are HIV seropositive as of the end of 2003, HIV dementia (HIV-D) has likely become the most common form of dementia among young adults world-wide, and along with Alzheimer''''s disease and vascular dementia among the most common forms of dementia. Yet, little is known about HIV-D in the developing world and its response to highly active antiretroviral therapy (HAART). Our proposal will address these fundamentally important public health questions. The proposal focuses on a specific site, Uganda which has the sufficient institutional development necessary, including human resources and appropriate infrastructure for clinical care, as well as strong support from the national government, to make the project feasible. The prevalence of HIV-D in Uganda is unknown, but a recent study performed by our group at the Infectious Disease Clinic at Mulago Hospital in Kampala, Uganda suggests that HIV-D may be seen in approximately 30% of HIV+ patients presenting to the clinic. The case example of Uganda and the tools developed from this proposal will have wider applicability not only for HIV-associated neurological research elsewhere in Africa but also for developing countries in other continents.

PRIMARY OBJECTIVE(S) AND ENDPOINT(S):
Primary Aim: To determine whether HAART improves neuropsychological test performance among HIV+ individuals in Uganda with dementia.
Subaim 1: To determine whether systemic virological control correlates with improvement in neuropsychological test performance among HIV+ individuals in Uganda with dementia.
Subaim 2: To determine whether HAART improves functional performance among HIV+ individuals with cognitive impairment.

HYPOTHESES:
Primary Aim: Neuropsychological test performance among HIV-D patients in Uganda will improve after 6 months of HAART.
Subaim 1 Hypothesis: Systemic virological suppression will correlate with improvement in neuropsychological test performance among HIV-D subjects.
Subaim 2 Hypothesis: Functional performance among HIV-D patients with cognitive impairment will improve after 6 months of HAART