We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Therapy Recommendations for HIV-Associated Neurocognitive Disorders—Reply

Melanie A. Thompson, MD; Scott M. Hammer, MD
JAMA. 2008;300(21):2482-2483. doi:10.1001/jama.2008.734.
Text Size: A A A
Published online


In Reply: Dr Zirulnik raises a point that can affect not only the timing of when to start antiretroviral therapy, but the definition of symptomatic HIV infection. Since our first report was published in 1996,1 the International AIDS Society–USA Antiretroviral Guidelines Panel has consistently recommended beginning therapy in the setting of symptomatic HIV disease. However, at that time, symptomatic disease was seen more narrowly (AIDS-defining opportunistic diseases; recurrent mucosal candidiasis; oral hairy leukoplakia; and chronic unexplained fever, night sweats, and weight loss). It is now recognized that symptoms and signs of uncontrolled HIV replication, such as subtle neurocognitive changes, exist even at higher CD4 cell counts.2,3 Although HIV encephalopathy and dementia would be classified as “classic” symptomatic disease triggering initiation of therapy, confirmed subtle neurocognitive changes should also be included in the definition of symptomatic HIV disease, and therapy would be warranted. Before attributing symptoms and signs to HIV, careful evaluation should exclude other treatable causes such as depression and substance abuse.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




December 3, 2008
Jorge L. Zirulnik, MD
JAMA. 2008;300(21):2482-2483. doi:10.1001/jama.2008.733.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.