Antidepressant May Improve Cognitive Damage in HIV-Positive People

Although with the right treatment people living with HIV can now live a long and healthy life, many still can experience complications that current antiretroviral medications don't treat. Cognitive damage and chronic inflammation are common side effects that can result from HIV, particularly in people who have been living with the disease for a long time. 

Studies have shown that HIV-associated brain disorders can cause significant health impacts, accelerate the aging process, and increase death-rates. Meanwhile, increased inflammation is linked to cancer, heart disease, kidney failure, dementia and autoimmune diseases.

Fortunately, researchers from John Hopkins University School of Medicine recently discovered that an existing anti-depression drug may be able to ameliorate these health concerns and improve the quality of life for those aging with HIV

In a small, controlled study, the antidepressant drug paroxetine (Paxil) boosted mental functions related to cognitive damage and suppressed inflammation for patients with HIV. The drug improved reaction time and decision-making and moderately suppressed inflammation in patients known to have HIV-associated neurocognitive disorders.

"Over a period of 20 years and after 10 clinical trials, this is the first time we have been able to clearly demonstrate benefit in a summary measure of cognitive performance for patients with HIV-associated neurocognitive disorders," said lead author Ned Sacktor, a neurology professor at Johns Hopkins University, noting the groundbreaking nature of the findings. 

Even when virally suppressed, people living with HIV can still experience inflammation as a result of the disease. HIV-associated neurocognitive disorders (HAND) occur when this inflammation occurs in the brain causing damage to nerve cells. People who suffer from HAND can often experience difficulty with learning, decision-making, motor function, and memory.

Remarkably, this drug seems capable not just of stopping the mental decline but also of reversing some of the damage.  In an earlier study published in 2014, Sacktor and his team found two FDA-approved drugs, (paroxetine and the antifungal fluconazole) showed promising results.

To ascertain the effect the drugs could have on safely suppressing inflammation and reversing cognitive impairment, the research team led a 24-week trial that consisted of 45 patients with cognitive impairment divided into four control groups. Depending on the group, participants were either given 20 milligrams of paroxetine per day, 100 milligrams of the anti-fungal drug fluconazole twice a day, a combination of the two drugs, or a placebo.

Participants who took paroxetine alone saw a significant improvement in decision-making and reaction time than those not taking the antidepressant drug. Researchers thought positive results might be related to inflammation.  They examined blood samples from patients, and discovered that the drug had reduced levels of inflammatory proteins in their bodies.

“By reducing inflammation, we hoped to have the added benefit of improving cognition, and our results show that to be the case,” says Sacktor.

Fluconazole did not yield the same results, prompting the research team to abandon any further evaluation of the drug.

Paroxetine is currently approved to treat obsessive-compulsive disorder, post-traumatic stress disorder, anxiety, panic attacks, and depression. The drug is classified as a selective serotonin reutake inhibitor.

Because it has already passed testing for safety, parozetine shouldn't have to go through the lengthy trials that can delay FDA-approval. Which could dramatically reduce the time before the treatment is available.