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Neurologists who study AIDS have watched, waited and worried for nearly a decade about the long-term effect of HIV on the brain. They've known that the drug cocktails that so effectively extend lives don't protect the brain very well from the virus.

Now they have their first actual look at the destruction HIV causes in living brains. A study published by the National Academy of Sciences recently used 3-D brain scans to see how much tissue was damaged. In vivid, color-coded images, researchers found up to 15 percent tissue loss in the centers that regulate movement and coordination, as well as a thinning of the language and reasoning centers.

"As people are living longer, the major risk of HIV is not the immune system anymore, but the brain," said Dr. Paul Thompson, professor of neurology at the University of California, Los Angeles, and author of the brain-scan study. "People who are doing well with HIV, living with it for over 10 years, have this progressive damage going on in the brain."

For the more than 1 million Americans living with HIV, the virus that causes AIDS, it could mean minor problems with forgetfulness -- or it could mean early-onset dementia on the horizon.

It has long been understood that the drugs that keep HIV in check, like many other medicines, don't get to the brain in the same way they get to other organs. That's because blood vessels in the brain are less permeable than those elsewhere in the body and have an additional coating to prevent blood leakage into brain cells.

Susan Brink is a reporter for the Los Angeles Times, a Tribune Publishing newspaper.