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Last Updated on June 12, 2023

With the right treatment, HIV-positive people can live long and healthy lives. However, many still face complications that cannot be treated with antiretroviral drugs.

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Common manifestations of HIV infection include cognitive impairment and chronic inflammation. These are particularly common in people with a long history of the disease. However, researchers at the Johns Hopkins University College of Medicine have recently found that a drug used to treat depression may reduce these adverse effects and improve the quality of life of people living with HIV.

According to a small controlled trial, the antidepressant paroxetine improves thinking functions impaired by cognitive impairment and suppresses inflammation in people with HIV infection. The drug was found to improve reaction time and decision-making and moderately suppress inflammation in patients with HIV-associated neurocognitive impairment.

“After 20 years and 10 clinical trials, we have for the first time clearly demonstrated the positive effect of comprehensive interventions to improve cognitive function in patients with HIV-associated neurocognitive disorders,” said senior study author Ned Sactor, professor of neurology at Johns Hopkins University.

Even when the virus is suppressed, HIV-infected people can experience inflammatory complications associated with the disease. HIV-associated neurocognitive disorders (VARN) occur when inflammation damages nerve cells in the brain. Patients with VARN often have difficulty learning and making decisions, as well as impaired motor function and memory.

To confirm the safe effects of antidepressants in suppressing inflammation and neutralising cognitive impairment, Professor Sactor and colleagues chose two drugs to study: paroxetine and the antifungal drug fluconazole. Both drugs are approved by the US Food and Drug Administration (FDA) and had shown encouraging results in a previous trial published in 2014.

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The 24-week trial included four groups of patients with cognitive impairment – 45 people in total. Depending on the group, subjects received either 20 mg of paroxetine daily or 100 mg of fluconazole twice daily, or a combination of both drugs, or a placebo.

Patients who took only paroxetine reported significant improvements in decision-making processes and reaction times compared to those who did not take the antidepressant. Researchers found decreased levels of inflammatory proteins in blood samples from patients who took the drug. Taking fluconazole did not produce these results, prompting the researchers to abandon further evaluation of the drug.

“We had hoped that suppressing inflammation would give us an additional benefit in the process of improving cognitive ability, and our results confirmed this,” notes Sactor.

Paroxetine is currently approved for obsessive-compulsive disorder, post-traumatic stress disorder, anxiety, panic attacks and depression. It is a selective serotonin reuptake inhibitor.

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