A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF DEPRENYL AND THIOCTIC ACID IN HUMAN IMMUNODEFICIENCY VIRUS-ASSOCIATED COGNITIVE IMPAIRMENT

Cognitive impairment is a frequent manifestation of advanced human imm unodeficiency virus (HIV) infection. The response to antiretroviral me dication is often partial and poorly sustained. Recent studies suggest that free radical production within the CNS and neuronal apoptosis ma y play important roles in the pathogenesis of HN dementia. We conducte d a randomized double-blind, placebo-controlled trial using a parallel group, 2 x 2 factorial design evaluating deprenyl, a monoamine oxidas e B inhibitor and putative anti-apoptotic agent, and thioctic acid, an antioxidant, in 36 patients with HIV-associated cognitive impairment. Both deprenyl and thioctic acid were well tolerated with few adverse events. Deprenyl recipients showed significant improvement on tests of verbal memory compared with patients not taking deprenyl. Thioctic ac id treatment did not improve cognitive function. These results suggest that deprenyl treatment is associated with cognitive improvement in s ubjects with mild HN-associated cognitive impairment, whereas thioctic acid has no benefit. A larger efficacy trial is needed to assess the long-term effect of deprenyl on cognitive performance in patients with HIV infection.