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Address correspondence and reprint requests to Dr. Ned Sacktor, Johns Hopkins Bayview Medical Center, Department of Neurology, B-122, 4940 Eastern Ave., Baltimore, MD 21224.
Cognitive impairment is a frequent manifestation of advanced human immunodeficiency virus (HIV) infection. The response to antiretroviral medication is often partial and poorly sustained. Recent studies suggest that free radical production within the CNS and neuronal apoptosis may play important roles in the pathogenesis of HIV dementia. We conducted a randomized double-blind, placebo-controlled trial using a parallel group, 2x 2 factorial design evaluating deprenyl, a monoamine oxidase 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 acid treatment did not improve cognitive function. These results suggest that deprenyl treatment is associated with cognitive improvement in subjects with mild HIV-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.
*Members of the Dana Consortium on the Therapy of HIV Dementia and Related Cognitive Disorders and their affiliations are listed in theAppendix on page 650.
Supported by the Charles A. Dana Foundation and by the National Institutes of Health (NIH) General Clinical Research Centers at Rochester (RR00044), Johns Hopkins University (RR00722), and Columbia University (RR00645); by grants 5-P50 MH43520 from NIH and the National Institute of Mental Health(Anke A. Ehrhardt, PhD, PI) at Columbia University; and by grants NS26643 at Johns Hopkins University.
Received June 2, 1997. Accepted in final form August 13, 1997.
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