(for central-nervous-system HIV antiretroviral therapy-effects research)

That large-scale study, called CHARTER (for central-nervous-system HIV antiretroviral therapy-effects research), began in 2002 and received $38 million in NIH grants to follow 1,500 patients. According to Igor Grant, a University of California, San Diego, neurologist who heads the effort, motor skills are often impaired as well. Some patients develop a tremor or experience difficulty with balance. Some experience seizures, and others appear to undergo fundamental character changes, not uncommon in brain injuries. “I have many patients who say their personalities have changed, or their partners say, ‘He’s nicer,’ or ‘He’s meaner,’ ” says Anthony Geraci, an HIV neurologist in Manhattan. Some even develop interests in areas that had never fascinated them in the past, he says. “Certain parts of their brain will be released, if you will, and they start being able to do things they couldn’t do before.”

There’s significant controversy over these findings. Because the deficits can be relatively minor, many patients have had trouble convincing friends and family—even their own doctors—that they’re experiencing significant symptoms. “This is largely unnoticeable for most people, in my impression,” says Judith Rabkin, a researcher at the New York State Psychiatric Institute and Columbia University’s psychiatry department. As a specialist in HIV-related psychiatric issues, she treats hundreds of patients with these issues, many of whom are poor and have other reasons to complain of dementia, like long histories of substance abuse or co-infection with hepatitis C. But unless they have relatively complex jobs, the deficits may not ever cause problems, she says. “Up to 80 percent of our patients you could classify as impaired, but it doesn’t impact their everyday lives.” (In a related criticism, the activist Mike Barr wonders what sort of HIV patients are enrolling in these neuropsychology studies. “From my perspective, ‘normal’ HIV-positive folks either are unwilling to enter in these sorts of studies, are not attracted by the customary financial incentives to participate, or are simply happy/satisfied with the care they are getting from their HIV specialist,” he wrote to me in an e-mail.)