text:
The Transitional Assistance Management Program (TAMP) offers transitional TRICARE coverage to certain separating active duty members and their eligible family members. TRICARE eligibility under the TAMP is good for up to 180 days. Care is available for a limited time. The following is a summary of the TAMP program:
- The Four Categories for TAMP Eligibility
- TRICARE Prime Enrollment and Reenrollment
- New Dental Benefits for Guard and Reserve
- TAMP Eligibility
- Continued Health Care Benefit Program
- Voluntary Separation Benefits
The Four Categories for TAMP are:
- Members involuntarily separated from active duty and their eligible family members;
- National Guard and Reserve members, collectively known as the Reserve Component (RC), separated from active duty after being called up or ordered in support of a contingency operation for an active duty period of more than 30 days and their family members
- Members separated from active duty after being involuntarily retained in support of a contingency operation and their family members; and
- Members separated from active duty following a voluntary agreement to stay on active duty for less than one year in support of a contingency mission and their family members.
Active duty sponsors and family members enrolled in TRICARE Prime who desire to continue their enrollment upon the sponsor's separation from active duty status are required to reenroll. To reenroll, the sponsor or family member must complete and submit a TRICARE Prime enrollment application.
Under TAMP, former active duty sponsors, former activated reservists, and family members of both are not eligible to enroll or reenroll in TRICARE Prime Remote or in TRICARE Prime Remote for Active Duty Family Members because both programs require the sponsor to be on active duty. Under the TAMP, the sponsor is no longer on active duty and is treated as an active duty family member for benefits and cost sharing purposes.
TRICARE Prime Enrollment and Reenrollment
Initial enrollment in TRICARE Prime occurs during the TAMP period
Family members whose applications are received through the 20th of the month are enrolled the first day of the next month. Family members whose applications are received after the 20th of the month are enrolled the month that follows. For example, if the application is received June 20, TRICARE Prime coverage for the family member begins July 1. If the application is received June 21, coverage for the family member begins Aug. 1.
Reenrollment in TRICARE Prime during the TAMP period
Members and their eligible family members who want to retain TRICARE Prime, must complete an application to reenroll in TRICARE Prime. This reenrollment form will ensure that TRICARE Prime coverage continues with no break in coverage.
New Dental Benefits for Guard and Reserve
National Guard and Reserve members separating from active duty after an activation of greater than 30 days in support of a contingency operation may now receive the same dental care benefits as active duty service members. The TRICARE Active Duty Dental Program (ADDP) now provides coverage to these members in the Transition Assistance Management Program (TAMP).
ADDP beneficiaries receive active duty dental benefit services as long as the referral and/or authorization requirements are met prior to receipt of care. Authorizations will not be granted for any dental care procedure that cannot be completed within their 180-day maximum TAMP period.
Eligibility is verified by ADDP contractor United Concordia Companies, Inc. using the Defense Enrollment Eligibility Reporting System (DEERS). All TRICARE beneficiaries are advised to keep their enrollment information updated in DEERS; if eligibility cannot be confirmed, ADDP dental care will be denied.
TAMP provides 180 days of transitional health care benefits to help certain uniformed services members and their families transition to civilian life. Benefits begin the day after the service member is separated from active duty. Family members and dependents are not eligible for ADDP benefits under TAMP, but remain eligible to purchase coverage through the TRICARE Dental Program (TDP). Service members receiving benefits under TAMP are ineligible for the TDP until the end of the 180-day transitional benefit period.
TAMP Eligibility
Eligibility for the TAMP for sponsors and family members is determined by the sponsor's Service branch and information in the Defense Enrollment Eligibility Reporting System. Sponsors may verify eligibility for themselves and their family members by visiting or contacting the nearest military identification card issuing facility or contacting the Defense Manpower Data Center Support Office toll free at (800) 538-9552. For additional TRICARE benefit information, sponsors and family members may visit the TRICARE Website. They also may contact their regional managed care support contractor or TRICARE Service Center representative. A list of the regional toll-free numbers is available on the TRICARE Website at www.tricare.mil/regionalinfo.
Continued Health Care Benefit Program (CHCBP)
After the TAMP eligibility expires, members and eligible family members may choose to enroll in CHCBP. CHCBP provides a conversion health plan similar to TRICARE Standard for a specific time (18 months) to former service members and their families who pay quarterly premiums. Eligible persons must enroll in the CHCBP within 60 days after separation from active duty or loss of eligibility for military health care under TAMP.
For more information about CHCBP, interested parties may check with a beneficiary counseling and assistance coordinator or call the contractor that runs the program toll free at (800) 444-5445. They can also refer to the CHCBP page of the TRICARE Website, or write to:
Humana Military Healthcare Services, Attn: CHCBP P.O. Box 740072 Louisville, KY 40201.
Detailed information regarding the CHCBP is available online at www.humana-military.com. Eligibility for CHCBP is determined through the military personnel offices.
Voluntary Separation Benefits
Service members who voluntarily separate under the Special Separation Benefit (SSB) or the Voluntary Separation Incentive (VSI) options will be entitled to all of the benefits provided for involuntarily separated members. Members who choose the SSB or VSI options (and their families) may continue their health benefits by enrolling in CHCBP.


text:
This post was compiled by our friends at chron.com.
A photo of a smiling, recovering George H.W. Bush is making the rounds in social media.
The 88-year-old former president, who was recently released from Methodist Hospital after a seven-week stay, was spotted at a Galleria-area restaurant on Saturday night, according to the The Hill and CultureMap Houston.
CultureMap says Bush enjoyed dinner with family at Gigi's Asian Bistro & Dumpling Bar in the Galleria area. A photo on Instagram shows the 41st president hanging out with well-wishers. CultureMap identified the two men in the photo as Mark Sullivan and Jason Reeves.
The restaurant is a Bush favorite. It provided Christmas dinner for the family as relatives visited Bush in the hospital.
According to CultureMap, Janet Shamlian, a Texas-based NBC News reporter, posted the photo, and it was picked up all over the world, including in the Daily Mail in London and The Huffington Post.
Bush was hospitalized for weeks after suffering a persistent cough and fever.

subset: commoncrawl


text:
For the police car in The Ballad of Gay Tony, see Police Stinger. For the police equipment, see Spike Strip.
- "What a great car. Always wanted one of these."
- — GTA Vice City Website.
The Grotti Stinger is a two-door sports car which originally debuted in the original Grand Theft Auto, and recurred in the form of different designs. To date, the Stinger has appeared in the following games:
- Grand Theft Auto 1
- Grand Theft Auto 2
- Grand Theft Auto III
- Grand Theft Auto: Vice City
- Grand Theft Auto: Liberty City Stories
- Grand Theft Auto: Vice City Stories
- Grand Theft Auto V
In GTA 1, the Stinger based on the 1968-1972 Chevrolet Corvette (the name is a reference to the Corvette Stingray). In GTA 2 it's based on the 1963 Corvette Split-Window. It can only be found in the Industrial District of Anywhere City, and gives the ElectroFingers power-up when crushed. Both iterations handle great, respond well, and stick to the road.
GTA III — GTA Vice City Stories
In GTA III and GTA Liberty City Stories, the Stinger appears in hard-top and convertible form. Its performance is better than most vehicles, but is the least powerful of all the 2-door sports cars, with little tendency to drift. Its Yakuza variant, the Yakuza Stinger, handles better and is all-wheel-drive, as opposed to the stock cars, which are rear-drive. The Stinger in both games is a cross resemblance between Porsche Boxster and Toyota MR2 Spyder. The front of the car and also the total shape also has a likeness to the Pontiac Solstice; this is certainly just coincidental, given that the Solstice was not revealed until 2004, 3 years after GTA III went on sale and 4 years after the game went into production.
In GTA Vice City and GTA Vice City Stories, it resembles a 1968-1973 Ferrari Daytona Spyder, an apparent homage to Sonny Crockett's Ferrari Daytona Spyder replica, yet another one of GTA Vice City's references to Miami Vice.
A working name given to the Stinger in Grand Theft Auto III is "Shark", as evidenced in the "official" website for Capital Autos [1].
- "First manufactured in 1960, the Stinger quickly became a car synonymous with the hard-living Vinewood playboys of the silver screen. Literally hundreds of impressionable young starlets got drunkenly deflowered against their will on the hood of this beauty and then later ended up with a face through the windshield. $1 million buys you more than just a used car without power steering - it buys you a piece of history. The interior still reeks of bourbon and cigarettes."
- ―Legendary Motorsport webpage
In Grand Theft Auto V, the Stinger is a hybrid of an Alfa Romeo 33 Stradale and/or Ferrari Dino (front), and a BMW 507 (rear). Only available via purchase from the Legendary Motorsport website for $1 million, the car boasts a relatively high speed and acceleration, on par with several sports coupes such as the Sentinel XS. At high speeds however, the car has the tendency to fishtail when turning, and on some occasions powerslide off the road.
Notable Owners
- In the beta version of GTA Liberty City Stories, there was a yellow Stinger supposedly reserved for use by the Sicilian Mafia. Its was possibly going to be called the Sicilian Stinger. But then it turned into a normal silver/white Stinger for the final version. If this is the case, it is likely due to the already existing Yakuza Stinger.
- The GTA Vice City rendition of the Stinger made an appearance in Manhunt 2.
- Even though the Stinger does not appear in GTA San Andreas, a beta model exists within San Andreas' coding. The model is the same as Vice City's, albeit the headlights are different
- Aside from the fact the Stinger in GTA Vice City is based on Sonny Crockett's Ferrari from Miami Vice, several other references to the car from the TV show are present in the game:
- The Stinger shares its name with the Stinger Missile, which was used to blow up Crockett's Ferrari in season 3 of Miami Vice.
- A Stinger is found parked outside the Downtown Police Station in Downtown Vice City, referencing the car's use on the cop show.
- In GTA: Liberty City Stories, if the player is armed with a Sub Machine Gun the gun will stick out the front windscreen, even if the window is still intact.
- Strangely, in GTA Vice City, the Stinger is front-wheel drive, which is unusual for a sports car.
- The hardtop variant in GTA Liberty City Stories somewhat bear similarities with Daihatsu Copen, a Japanese compact sports car. However this is coincidental. as Daihatsu Copen is introduced in 2002, roughly four years after the events of LCS.
- In the GTA V mission Pack Man, a red Stinger can be seen on the Packer. However, unlike the other five cars, there is no corresponding mission to steal the Stinger. In fact, nothing is known about why it is present.
- Appears in traffic in all three cities: Liberty City, San Andreas and Vice City.
- Only appears in traffic in the Residential District.
- Driven around Staunton Island and Shoreside Vale.
- Parked in a back lot car park on the southwestern most block in Bedford Point, Staunton Island.
- Parked by a mansion garage in Cedar Grove, Shoreside Vale.
GTA Vice City
- Very usually seen in north Downtown.
- Around Leaf Links Golf Club. Seen commonly on the bridge that connects Vice City Midland and Mainland.
GTA Liberty City Stories
- Driven around Staunton Island and Shoreside Vale.
- Parked at a driveway of the second easternmost house (next to the future Cartel mansion), Cedar Grove, Shoreside Vale.
GTA Vice City Stories
- Parked just north of where the Police car is parked at the Downtown Police Station.
- Parked in the InterGlobal Films studio in Prawn Island (sometimes appears in place of the Deluxo).
- Spawns in Ocean Drive, along a row of parked cars in Ocean Beach.
- Parked by a mansion in Starfish Island.
- Behind the Malibu Club on the beach island.
- Parked in front of the hotel on the east side of Vice Point Mall, Vice Point.
- May be bought for $1,000,000 on Legendarymotorsport.net.
- Yakuza Stinger
- During the mission "Grand Theft Auto" in GTA III, Claude has to deliver a unique plum colored Stinger.
See also
- Stinger Z29, a sports car in GTA 1.
- Police Stinger, a police car and fastest car in The Ballad of Gay Tony bearing no similarities with any earlier Stinger.
- Yakuza Stinger, the Yakuza version of the Stinger in GTA III, GTA Advance and GTA Liberty City Stories.


text:
Shaun Livingston had another nice game Friday night with 13 points, 5 rebounds, 6 assists and 3 steals in 38 minutes. If you're waiting for Kyrie Irving to return and save your team, you're just as sad and depressing as every other Cavs fan and you may be disappointed. Don't wait till its too late, any player is better than an injured player in the playoffs because injured players don't play! Fact! Meanwhile, Shaun Livingston is just 12% owned and averaging 12.5 points, 6 assists and 3.5 rebounds in two games starting since Irving went down. He also chipped in 4 steals and a block in that span. Livingston is not a huge scorer, but he could provide decent value in some other categories and will get plenty of burn in the Cleveland back court if you are looking for a player to help down the stretch.
Here's what else happened in fantasy basketball Friday night:Please, blog, may I have some more?


text:
Don Draper may act like he answers to no one, but Jon Hamm respects the "Mad Men" hierarchy.
Series creator Matthew Weiner prohibits the actors from leaking any storyline teases, but Hamm knows how to work around it by dishing some behind-the-scenes details – and, after directing the season's debut episode, he's just as insider-y as the show's own take on the '60s ad world.
Are you as excited about arrival of the new season – at last – as the viewers?
I am very excited. Absence makes the heart grow fonder, we hope, so, I'm thrilled. We were happy to come back to work. I'm happy to almost be done with work and I'm thrilled to get it on the air, honestly.
What can you talk about in terms of your feelings about playing Don this season?
We had a very long break, and it was hard. It felt weird and strange because we were gone so long. Then when we got back the ramp-up period was a little shallower. We didn't ramp right back into it, but once we locked in it was pretty great. It was really fun. I love my job. I love Matt Weiner's writing.
Can you talk about directing actors that you've worked with as a colleague?
U.S. & World
News from around the country and around the globe
It was great, honestly. Part of it is that we're all very close and we're all very good friends and we've all worked together now for almost six years. So for me it was very easy to say, 'Okay, that was great. Let's do it again. Let's try it a different way,' kind of simple direction and not too complicated. I didn't try to overreach my grasp or whatever that thing is. I didn't try to do too much. It wasn't about camera moves. I wasn't trying to do be David Fincher. Part of it was like, 'Let's see if I can do this and not run the train off the tracks.'
Is there a danger when you direct your friends?
I don't know if I would call it dangerous. I think that everybody realized that, because we had done it with John Slattery the year before, twice, and it was great. It was a really nice experience and everyone was very supportive, so that kind of carried over onto my episode. People were supportive, and not just the cast. The crew, everybody was like, 'Let's make our day.' We had some very challenging shoot days with extras and this and that and locations.
Where were you?
We were on the space shuttle. That was one. The Matterhorn, that was another one. [Laughs]
Was it difficult directing when you were in the scene?
It's not that hard. You have playback, so you can go and you can watch. It just takes a little longer because you're not really watching it in real time. You have to go back, spin it back and watch it again. It was tricky, but it wasn't that hard. I'm one of those people that doesn't necessarily have a hard time watching themselves. I don't get too wound up and freaked out. If I was I don't think that I would've chosen to direct. It would've been very hard, so I was like, 'Okay, let's do it again. I was terrible. Let's do it again.' I'm not ashamed of calling myself out.
Where are you aspirations as far as directing more and do you want to keep it to television or are you thinking feature film?
I realize the incredible vision and dedication it takes to shepherd a feature film into existence. I watched Ben Affleck do it [on 'The Town'] and I was like, 'Hats off to you.' I just recently watched my girlfriend [Jennifer Westfledt] do it and I watched her work 24/7 for the better part of a year and it takes a tremendous amount of focus, a tremendous amount of drive and just a tremendous amount of work – whereas in television so many of those decisions are already made. There's already an apparatus in place. There're already departments in place. There's already a machine that's set to 'lets' go' and you don't have to get that up and running. So I would definitely do it again, but I would do TV again and I would love to do it in a place where I feel as comfortable as I feel on the 'Mad Men' set.
Can you talk about the first table read you guys had when you came back?
It was fun, very fun. I was directing and so that was a weird thing. We're very supportive. I think that everyone was excited to be back to work and I think that's from Matt on down. Everybody was jazzed to be back up and running. It was different and fun for me to be in a different chair, in the director's part, so that was a little bit exciting and gave it enough of a new flavor and then we were back into it.
Does each season feel like a history lesson, do you learn something about the era that you didn't previously know? Not so much for the audience, but for you?
No. I think the closest thing that I could say to things like that are like, 'Oh, that was when that happened – right,' some whatever-thing it was. 'Oh, yeah, that was that – right,' not having been alive during that time. So it doesn't necessarily feel like a history lesson and we try to really minimize that because whenever people talk about The '60's with a capital T, capital S ,it always feels like it's this weird, important thing. We try to make it a story about these people that happened to take place during this time.
How would you like to see the show move into the '70's with a new wardrobe – a little polyester?
Well, it would have to move in to the awfully late '70's. I don't think that Don is going to Studio 54, but you never know.


text: Yowza! would I like to get one of these bad boys! I'm definitely one for cuddlin' and when I can't get the real deal this is a fine substitute. At least it won't push away, or adjust because they're "uncomfortable" or pass gas in the middle of "the mood". This is a bit big for stocking stuffer, but doesn't mean you can't make a giant stocking!!!!


text:
Spar (Feat. Big Ev) - Let That Kitty Cat Go [Unsigned Hype][Fixed]
For more videos: youtube.com/sparmusic277
For more music: http://www.jango.com/music/Spar
Myspace:http://www.myspace.com/sparddfcrew Twitter: twitter.com/sparmusic
facebook: http://www.facebook.com/#!/pages/SparMusic/144693632224632
Become a member of Hood Estate Today: Hoodestate.com
Please click the "Report" button below if the video on this page is not working properly.
Comments will only be displayed by verified emails. No Spamming or Racism.


text:
- What Is AIDS?
- How Does AIDS Affect the Nervous System?
- What Are Some of the Neurological Complications That Are Associated With AIDS?
- How Are These Disorders Diagnosed?
- How Are These Disorders Treated?
- What Research Is Being Done?
- Where Can I Get More Information?
What Is AIDS?
AIDS (acquired immune deficiency syndrome) is a condition that occurs in the most advanced stages of human immunodeficiency virus (HIV) infection. It may take many years for AIDS to develop following the initial HIV infection.
Although AIDS is primarily an immune system disorder, it also affects the nervous system and can lead to a wide range of severe neurological disorders.
How Does AIDS Affect the Nervous System?
The virus does not appear to directly invade nerve cells but it jeopardizes their health and function. The resulting inflammation may damage the brain and spinal cord and cause symptoms such as confusion and forgetfulness, behavioral changes, severe headaches, progressive weakness, loss of sensation in the arms and legs, and stroke. Cognitive motor impairment or damage to the peripheral nerves is also common. Research has shown that the HIV infection can significantly alter the size of certain brain structures involved in learning and information processing.
Other nervous system complications that occur as a result of the disease or the drugs used to treat it include pain, seizures, shingles, spinal cord problems, lack of coordination, difficult or painful swallowing, anxiety disorder, depression, fever, vision loss, gait disorders, destruction of brain tissue, and coma. These symptoms may be mild in the early stages of AIDS but can become progressively severe.
In the United States, neurological complications are seen in more than 40 percent of adult patients with AIDS. They can occur at any age but tend to progress more rapidly in children. Nervous system complications in children may include developmental delays, loss of previously achieved milestones, brain lesions, nerve pain, smaller than normal skull size, slow growth, eye problems, and recurring bacterial infections.
What Are Some of the Neurological Complications That Are Associated With AIDS?
AIDS-related disorders of the nervous system may be caused directly by the HIV virus, by certain cancers and opportunistic infections (illnesses caused by bacteria, fungi, and other viruses that would not otherwise affect people with healthy immune systems), or by toxic effects of the drugs used to treat symptoms. Other neuro-AIDS disorders of unknown origin may be influenced by but are not caused directly by the virus.
AIDS dementia complex (ADC), or HIV-associated encephalopathy, occurs primarily in persons with more advanced HIV infection. Symptoms include encephalitis (inflammation of the brain), behavioral changes, and a gradual decline in cognitive function, including trouble with concentration, memory, and attention. Persons with ADC also show progressive slowing of motor function and loss of dexterity and coordination. When left untreated, ADC can be fatal.
Central nervous system (CNS) lymphomas are cancerous tumors that either begin in the brain or result from a cancer that has spread from another site in the body. CNS lymphomas are almost always associated with the Epstein-Barr virus (a common human virus in the herpes family). Symptoms include headache, seizures, vision problems, dizziness, speech disturbance, paralysis, and mental deterioration. AIDS patients may develop one or more CNS lymphomas. Prognosis is poor due to advanced and increasing immunodeficiency.
Cryptococcal meningitis is seen in about 10 percent of untreated AIDS patients and in other persons whose immune systems have been severely suppressed by disease or drugs. It is caused by the fungus Cryptococcus neoformans, which is commonly found in dirt and bird droppings. The fungus first invades the lungs and spreads to the covering of the brain and spinal cord, causing inflammation. Symptoms include fatigue, fever, headache, nausea, memory loss, confusion, drowsiness, and vomiting. If left untreated, patients with cryptococcal meningitis may lapse into a coma and die.
Cytomegalovirus (CMV) infections can occur concurrently with other infections. Symptoms of CMV encephalitis include weakness in the arms and legs, problems with hearing and balance, altered mental states, dementia, peripheral neuropathy, coma, and retinal disease that may lead to blindness. CMV infection of the spinal cord and nerves can result in weakness in the lower limbs and some paralysis, severe lower back pain, and loss of bladder function. It can also cause pneumonia and gastrointestinal disease.
Herpes virus infections are often seen in AIDS patients. The herpes zoster virus, which causes chickenpox and shingles, can infect the brain and produce encephalitis and myelitis (inflammation of the spinal cord). It commonly produces shingles, which is an eruption of blisters and intense pain along an area of skin supplied by an infected nerve. In people exposed to herpes zoster, the virus can lay dormant in the nerve tissue for years until it is reactivated as shingles. This reactivation is common in persons with AIDS because of their weakened immune systems. Signs of shingles include painful blisters (like those seen in chickenpox), itching, tingling, and pain in the nerves.
AIDS patients may suffer from several different forms of neuropathy, or nerve pain, each strongly associated with a specific stage of active immunodeficiency disease. Peripheral neuropathy describes damage to the peripheral nerves, the vast communications network that transmits information from the brain and spinal cord to every other part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord. HIV damages the nerve fibers that help conduct signals and can cause several different forms of neuropathy. Distal sensory polyneuropathy causes either a numbing feeling or a mild to painful burning or tingling sensation that normally begins in the legs and feet. These sensations may be particularly strong at night and may spread to the hands. Affected persons have a heightened sensitivity to pain, touch, or other stimuli. Onset usually occurs in the later stages of the HIV infection and may affect the majority of advanced-stage HIV patients.
Neurosyphilis, the result of an insufficiently treated syphilis infection, seems more frequent and more rapidly progressive in people with HIV infection. It may cause slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain. Symptoms, which may not appear for some decades after the initial infection and vary from patient to patient, include weakness, diminished reflexes, unsteady gait, progressive degeneration of the joints, loss of coordination, episodes of intense pain and disturbed sensation, personality changes, dementia, deafness, visual impairment, and impaired response to light. The disease is more frequent in men than in women. Onset is common during mid-life.
Progressive multifocal leukoencephalopathy (PML) primarily affects individuals with suppressed immune systems (including nearly 5 percent of people with AIDS). PML is caused by the JC virus, which travels to the brain, infects multiple sites, and destroys the cells that make myelin -- the fatty protective covering for many of the body's nerve and brain cells. Symptoms include various types of mental deterioration, vision loss, speech disturbances, ataxia (inability to coordinate movements), paralysis, brain lesions, and, ultimately, coma. Some patients may also have compromised memory and cognition, and seizures may occur. PML is relentlessly progressive and death usually occurs within 6 months of initial symptoms.
Psychological and neuropsychiatric disorders can occur in different phases of the HIV infection and AIDS and may take various and complex forms. Some illnesses, such as AIDS dementia complex, are caused directly by HIV infection of the brain, while other conditions may be triggered by the drugs used to combat the infection. Patients may experience anxiety disorder, depressive disorders, increased thoughts of suicide, paranoia, dementia, delirium, cognitive impairment, confusion, hallucinations, behavioral abnormalities, malaise, and acute mania.
Stroke brought on by cerebrovascular disease has been considered a somewhat rare complication of AIDS, although the association between AIDS and stroke may be much larger than previously thought. Researchers at the University of Maryland conducted the first population-based study to quantify an AIDS-associated stroke risk and found that AIDS increases the chances of suffering a stroke by as much as tenfold. Researchers caution that additional studies are needed to confirm this association. Earlier studies have indicated that the HIV infection, other infections, or the body's immune system reaction to HIV may cause vascular abnormalities and/or make the blood vessels less responsive to changes in blood pressure, which could lead to rupture and hemorrhagic stroke.
Toxoplasma encephalitis, also called cerebral toxoplasmosis, occurs in about 10 percent of untreated AIDS patients. It is caused by the parasite Toxoplasma gondii, which is carried by cats, birds, and other animals and can be found in soil contaminated by cat feces and sometimes in raw or undercooked meat. Once the parasite invades the immune system, it remains there; however, the immune system in a healthy person can fight off the parasite, preventing disease. Symptoms include encephalitis, fever, severe headache that does not respond to treatment, weakness on one side of the body, seizures, lethargy, increased confusion, vision problems, dizziness, problems with speaking and walking, vomiting, and personality changes. Not all patients show signs of the infection.
Vacuolar myelopathy causes the protective myelin sheath to pull away from nerve cells of the spinal cord, forming small holes called vacuoles in nerve fibers. Symptoms include weak and stiff legs and unsteadiness when walking. Walking becomes more difficult as the disease progresses and many patients eventually require a wheelchair. Some patients also develop AIDS dementia. Vacuolar myelopathy may affect up to 30 percent of untreated adults with AIDS and its incidence may be even higher in HIV-infected children.
How Are These Disorders Diagnosed?*
Based on the results of the patient's medical history and a general physical exam, the physician will conduct a thorough neurological exam to assess various functions: motor and sensory skills, nerve function, hearing and speech, vision, coordination and balance, mental status, and changes in mood or behavior. The physician may order laboratory tests and one or more of the following procedures to help diagnose neurological complications of AIDS.
Computer-assisted imaging can reveal signs of brain inflammation, tumors and CNS lymphomas, nerve damage, internal bleeding or hemorrhage, white matter irregularities, and other brain abnormalities. Several painless imaging procedures are used to help diagnose neurological complications of AIDS.
Computed tomography (also called a CTscan) uses x-rays and a computer to produce two-dimensional images of bone and tissue, including inflammation, certain brain tumors and cysts, brain damage from head injury, and other disorders. It provides more details than an x-ray alone.
Magnetic resonance imaging (MRI) uses a computer, radio waves, and a powerful magnetic field to produce either a detailed three-dimensional picture or a two-dimensional "slice" of body structures, including tissues, organs, bones, and nerves. It does not use ionizing radiation (as does an x-ray) and gives physicians a better look at tissue located near bone.
Functional MRI (fMRI) uses the blood's magnetic properties to pinpoint areas of the brain that are active and to note how long they stay active. It can assess brain damage from head injury or degenerative disorders such as Alzheimer's disease and can identify and monitor other neurological disorders, including AIDS dementia complex.
Magnetic resonance spectroscopy (MRS) uses a strong magnetic field to study the biochemical composition and concentration of hydrogen-based molecules, some of which are very specific to nerve cells, in various brain regions. MRS is being used experimentally to identify brain lesions in people with AIDS.
Electromyography, or EMG, is used to diagnose nerve and muscle dysfunction (such as neuropathy and nerve fiber damage caused by the HIV virus) and spinal cord disease. It records spontaneous muscle activity and muscle activity driven by the peripheral nerves.
Biopsy is the removal and examination of tissue from the body. A brain biopsy, which involves the surgical removal of a small piece of the brain or tumor, is used to determine intracranial disorders and tumor type. Unlike most other biopsies, it requires hospitalization. Muscle or nerve biopsies can help diagnose neuromuscular problems, while a brain biopsy can help diagnose a tumor, inflammation, or other irregularity.
Cerebrospinal fluid analysis can detect any bleeding or brain hemorrhage, infections of the brain or spinal cord (such as neurosyphilis), and any harmful buildup of fluid. A sample of the fluid is removed by needle, under local anesthesia, and studied to detect any irregularities.*
* See the NINDS publication, Neurological Diagnostic Tests and Procedures, for a comprehensive review of the diagnostic tests used in the treatment of AIDS patients.
How Are These Disorders Treated?
No single treatment can cure the neurological complications of AIDS. Some disorders require aggressive therapy while others are treated symptomatically.
Neuropathic pain is often difficult to control. Medicines range from analgesics sold over the counter to antiepileptic drugs, opiates, and some classes of antidepressants. Inflamed tissue can press on nerves, causing pain. Inflammatory and autoimmune conditions leading to neuropathy may be treated with corticosteroids, and procedures such as plasmapheresis (or plasma exchange) can clear the blood of harmful substances that cause inflammation.
Treatment options for AIDS- and HIV-related neuropsychiatric or psychotic disorders include antidepressants and anticonvulsants. Psychostimulants may also improve depressive symptoms and combat lethargy. Antidementia drugs may relieve confusion and slow mental decline, and benzodiazepines may be prescribed to treat anxiety. Psychotherapy may also help some patients.
Aggressive antiretroviral therapy is used to treat AIDS dementia complex, vacuolar myopathy, progressive multifocal leukoencephalopathy, and cytomegalovirus encephalitis. HAART, or highly active antiretroviral therapy, combines at least three drugs to reduce the amount of virus circulating in the blood and may also delay the start of some infections.
Other neuro-AIDS treatment options include physical therapy and rehabilitation, radiation therapy and/or chemotherapy to kill or shrink cancerous brain tumors that may be caused by the HIV virus, antifungal or antimalarial drugs to combat certain bacterial infections associated with the disorder, and penicillin to treat neurosyphilis.
What Research Is Being Done?
Within the Federal government, the National Institute of Neurological Disorders and Stroke (NINDS), one part of the National Institutes of Health (NIH), supports research on the neurological consequences of AIDS. The NINDS works closely with its sister agency, the National Institute of Allergy and Infectious Diseases (NIAID), which has primary responsibility for research related to HIV and AIDS.
Several NINDS-funded projects are studying the role of virally infected brain macrophages (cells that normally work to protect against infection) in causing disease in the central nervous system of adult macaques. The focus of these projects includes gene analyses and the study of key neuroimmune regulatory molecules that are turned on in the brain during the course of viral infection at levels that have been shown to be toxic.
Several animal-based models of HIV (including mouse, rat, and simian models) are used by scientists to study disease mechanisms and the course of AIDS, and NINDS grantees are working to develop new models of HIV. Several projects rely on a mouse model of severe combined immunodeficiency (a group of inherited disorders that are characterized by a lack of or severe defect in cells responsible for protecting the immune system). This model allows researchers to transplant developing human brain tissue from culture into the brains of the mice to monitor and assess neurologic damage caused by HIV infection. Other studies use mice bred to carry symptoms of HIV, and NINDS grantees are using these animals to see if the brain can function as a sanctuary for HIV-infected cells that can migrate to and infect peripheral lymph tissue.
The NINDS also supports research into the mechanisms of neurological illnesses related to immunodeficiency in AIDS patients. Several different investigators are studying the JC virus, which can reproduce in the brains of immunosuppressed patients and cause PML, and one study identified a novel receptor for the JC virus. Other studies of infectious agents include an investigation of the interaction of the fungal agent Cryptococcus with the blood vessels of the brain, and an analysis of neurosyphilis in people with AIDS. Scientists are also studying the effect of neurotoxic proteins and antiviral therapies directly on nerve cells as the cause for distal sensory peripheral neuropathy.
Several researchers are studying AIDS dementia and cognitive changes in HIV. NINDS-sponsored scientists are using fMRI and MRS to assess brain function and any behavioral deficits in HIV-affected individuals. Investigators hope to better understand how progressive neuronal cell death contributes to cognitive dysfunction and AIDS dementia. The National NeuroAIDS Tissue Consortium, a project supported jointly by the NINDS and its sister agency, the National Institute of Mental Health, is collecting tissues from people with AIDS who have suffered from dementia and other neurological complications of HIV infection for distribution to researchers around the globe.
The Neurological AIDS Research Consortium was established by the NINDS in 1993 to design and conduct clinical trials on HIV-associated neurologic disease. To date, the Consortium has supported studies of neurological function in advanced AIDS and the treatment of HIV-associated peripheral neuropathy, PML, and CMV infection. Consortium researchers are studying the drug selegiline as an add-on to antiretroviral therapy for HIV dementia, as well as the natural history of neurological disease in advanced HIV. Clinical studies have included a double-blind controlled study of prosaptide for the treatment of HIV-associated peripheral neuropathy, and trials of acetyl-L-carnitine and erythropoietin as treatments for toxic neuropathy in HIV infection.
Where Can I Get More Information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
Information also is available from the following organizations:
Elizabeth Glaser Pediatric AIDS Foundation
1140 Connecticut Avenue, NW
Suite 200
Washington, DC 20036
Tel: 202-296-9165 888-499-HOPE (-4673)
Fax: 202-296-9185
amfAR, The Foundation for AIDS Research
120 Wall Street
13th Floor
New York, NY 10005-3908
Tel: 212-806-1600
Fax: 212-806-1601
National Association of People with AIDS
8401 Colesville Road
Suite 750
Silver Spring, MD 20910
Tel: 240-247-0880
Fax: 240-247-0574
National NeuroAIDS Tissue Consortium
401 N. Washington Street
Suite 700
Rockville, MD 20850
Tel: 866-668-2272 301-251-1161 ext. 186
Fax: 301-576-4597
National Prevention Information Network
Centers for Disease Control and Prevention, DHHS
P.O. Box 6003
Rockville, MD 20849-6003
Tel: 301-562-1098 800-458-5231
Fax: 888-282-7681
National Institute of Allergy and Infectious Diseases (NIAID)
National Institutes of Health, DHHS
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
Tel: 301-496-5717
AIDSInfo (AIDS Information Service)
P.O. Box 6303
Rockville, MD 20849-6303
Tel: 301-519-0459 800-HIV-0440 (448-0440) TTY: 888-480-3739
Fax: 301-519-6616