Looking forward, looking back

A case study of a 34-year-old HIV-positive woman, who is on drug therapy and who has the genetic defect for Huntington's disease, raises questions regarding her long-term prognosis. Huntington's disease is a neurologic disorder marked by dementia and involuntary movement. Some of the personality changes that result from Huntington's disease, such as impulsive behavior and substance abuse, could put a patient at greater risk for being exposed to HIV. Patients with Huntington's disease are expected to eventually need institutionalization and death is usually expected within 15 to 20 years after diagnosis. Unlike HIV, Huntington's disease can only be transmitted vertically, and offspring are encouraged to get tested for the genetic disorder when they are of childbearing age. The success of antiretroviral treatments to prolong lives of HIV positive people gives rise to a host of ethical and logistical questions surrounding an aging HIV-positive population who have the potential to develop other chronic illnesses, such as Alzheimer's or Huntington's. Several questions need to be addressed, such as deciding who will have access to diverse genetic tests that are currently being developed, or will there be adequate facilities to care for HIV positive patients who develop multiple chronic illnesses. The patient in this case study decided to continue her therapy, but has difficulty keeping up with her medication as she progresses into dementia.