of dealing with HIV/AIDS among outreach workers and service providers (Broadhead and Fox, 1993).

CONCLUSION AND RECOMMENDATIONS

CONCLUSION

Examining the interactions among HIV infection, the central nervous system, and psychosocial factors related to disease progression and intervention makes it apparent that, although crucial insights have been gained, a number of urgent questions remain. The gaps in knowledge identified in this chapter point the way for future research at the institutes charged with focusing on the interactions of brain and behavior. Any successful approach to the prevention, treatment, and management of AIDS—especially as it becomes a more chronic disease—must combine highly focused research in many disciplines with integrative, cross-disciplinary efforts that synthesize the biological and psychosocial to address questions that range from understanding the molecular mechanisms of nerve cell dysfunction to identifying the specific health care problems of those with multiple diagnoses.

RECOMMENDATIONS FOR DISEASE PROGRESSION AND INTERVENTION

4.1 The committee recommends that NIMH continue research on the pathogenesis of HIV infection of the brain, including the factors controlling virus replication such as local immune defenses and changes in the viral genome determining neuropathogenicity.

4.2 The committee recommends that NIMH continue research on the pathobiology of nervous system injury underlying the AIDS dementia complex, including the morphological, biochemical, and molecular basis of neuronal dysfunction related to viral and cellular gene expression.

4.3 The committee recommends that NIMH support collaborative studies of the prevention and treatment of the AIDS dementia complex and other central nervous system complications of HIV infection.

4.4 The committee recommends that NIAAA, NIDA, and NIMH continue supporting research on the development of animal models for examining the basic neurochemical and behavioral changes associated with HIV/AIDS.



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