Combination fluconazole/paroxetine treatment is neuroprotective despite ongoing neuroinflammation and viral replication in an SIV model of HIV neurological disease

Kelly A. Meulendyke, Suzanne E. Queen, Elizabeth L. Engle, Erin N. Shirk, Jiayang Liu, Joseph P. Steiner, Avindra Nath, Patrick M. Tarwater, David R. Graham, Joseph L. Mankowski, M. Christine Zink

Research output: Contribution to journalArticlepeer-review

Abstract

Effective combined antiretroviral therapy (cART) in HIV-infected patients has made HIV a treatable infection; however, debilitating HIV-associated neurocognitive disorders (HAND) can still affect approximately 50 % of HIV-infected individuals even under cART. While cART has greatly reduced the prevalence of the most severe form of HAND, milder forms have increased in prevalence, leaving the total proportion of HIV-infected individuals suffering from HAND relatively unchanged. In this study, an in vitro drug screen identified fluconazole and paroxetine as protective compounds against HIV gp120 and Tat neurotoxicity. Using an accelerated, consistent SIV/macaque model of HIV-associated CNS disease, we tested the in vivo neuroprotective capabilities of combination fluconazole/paroxetine (FluPar) treatment. FluPar treatment protected macaques from SIV-induced neurodegeneration, as measured by neurofilament light chain in the CSF, APP accumulation in axons, and CaMKIIα in the frontal cortex, but did not significantly reduce markers of neuroinflammation or plasma or CNS viral loads. Since HIV and SIV neurodegeneration is often attributed to accompanying neuroinflammation, this study provides proof of concept that neuroprotection can be achieved even in the face of ongoing neuroinflammation and viral replication.

Original languageEnglish (US)
Pages (from-to)591-602
Number of pages12
JournalJournal of neurovirology
Volume20
Issue number6
DOIs
StatePublished - Dec 12 2014

Keywords

  • CNS
  • Fluconazole
  • HIV
  • Paroxetine
  • SIV
  • Selective serotonin reuptake inhibitor

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Virology

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