There is still no cure for the human immunodeficiency virus (HIV). While combination
antiretroviral therapy (cART) is effective in decreasing deaths from HIV, infected
individuals face a lifetime of treatment and many potential complications including end organ
diseases such as HIV-associated neurocognitive disorders. HIV infection is controllable with
antiretroviral therapy (ART), but ART cannot eliminate HIV reservoirs. Thus, there is no
available cure for HIV. There is a large and growing body of evidence that the central
nervous system (CNS) is an HIV reservoir site and a barrier to HIV eradication. Our group has
done extensive pre-clinical work with janus-kinase (JAK 1/2) inhibitors. This includes
baricitinib, which is an orally available, FDA-approved drug for rheumatoid arthritis.
Evidence suggests that this drug has activity against HIV in the central nervous system
(CNS). In our recently completed pilot study, we showed that baricitinib crosses the blood
brain barrier (BBB) and decreases HIV CNS persistence in the brain.
Using bloodwork, neurocognitive testing, MRIs and lumbar punctures, we plan to evaluate the
change in central nervous system HIV after treatment with baricitinib versus placebo. We will
also evaluate changes in neuroimaging, inflammation in blood and cerebrospinal fluid (CSF),
and neuropsychological performance after treatment with baricitinib versus placebo.
Evidence shows that the central nervous system is one of the reservoir sites that enables the
HIV virus to persist in the body even after years of treatment. In order to attack this
reservoir and eventually find a cure, it is vital to learn if certain medications can
suppress HIV in the CNS.