Role of psychiatric medications as adjunct therapy in the treatment of HIV associated neurocognitive disorders.
Effective combination antiretroviral therapies (ART) have markedly lengthened survival among HIV infected individuals. In this long-surviving cohort, both psychiatric comorbidities and HIV-associated neurocognitive disorders (HAND) remain common. Even mild neurocognitive impairment can significantly disrupt of activities of daily living and reduce quality of life. Persistence of HAND might reflect incomplete containment of HIV within the central nervous system (CNS) due to the limited penetration of most antiretrovirals (ARVs) across the blood-brain barrier. Recent data support that certain medications used to treat psychiatric comorbidities in HIV-infected individuals may also protect the brain from toxic byproducts of HIV replication and neuroinflammation. Two drug classes in particular, glycogen synthase kinase-3 beta (GSK-3b) inhibitors and serotonin reuptake inhibitors (SRIs), may benefit individuals with HAND. Valproic acid (VPA) and lithium are potentially beneficial GSK-3b inhibitors. While the mechanism of benefit of SRIs in HAND remains unknown, evidence supports some benefit of citalopram and paroxetine. The present brief review focuses on these drugs and assesses their possible adjunct roles in the treatment of HIV-infected individuals.
Ances
Beau M
BM
Department of Neurosciences, University of California, San Diego, California, USA.
Letendre
Scott L
SL
Alexander
Terry
T
Ellis
Ronald J
RJ
D023241:Antiretroviral Therapy, Highly Active; D001921:Brain / Q000503:physiopathology*; D015283:Citalopram / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D017374:Paroxetine / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014635:Valproic Acid / Q000627:therapeutic use
D015283:Citalopram; D016651:Lithium Carbonate; D017374:Paroxetine; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors; D014635:Valproic Acid