A Most Unusual Weapon in the Fight Against HIV: Foot CreamS

Ever heard of Ciclopirox? A commonly prescribed treatment for nail fungus, you could have a tube of the stuff in your medicine cabinet right now. Now, in a study recounted in the latest issue of PLOS ONE, researchers demonstrate that the antifungal agent can reactivate the same cell-death pathways that HIV turns off, thereby eliminating the infection itself.

Scientific American has the details on the study, which was led by Rutgers University researchers Hartmut Hanauske-Abel and Michael Matthews:

...not only does the drug Ciclopirox completely eradicate infectious HIV from cell cultures, but unlike today's most cutting-edge antiviral treatments, the virus doesn't bounce back when the drug is withheld. This means it may not require a lifetime of use to keep HIV at bay.

The same group of researchers had previously shown that Ciclopirox — approved by the FDA and Europe's EMA as safe for human use to treat foot fungus — inhibits the expression of HIV genes in culture. Now they have found that it also blocks the essential function of the mitochondria, which results in the reactivation of the cell's suicide pathway, all while sparing the healthy cells.

The researchers said that one aspect of HIV that makes it particularly persistent, even in the face of strong antiviral treatments, is its ability to disable a cell's altruistic suicide pathway — which is typically activated when a cell is damaged or infected. In other words, infected cells that would normally commit suicide to spare healthy cells no longer pull any altruistic kamikaze missions. Ciclopirox tricks these cells back into their old ways with a double negative, disabling the disabling of the suicide pathway.

The usual caveats, of course, apply. Just because a treatment works in a Petri dish doesn't mean it'll work in a living, breathing human. Lots of things can kill HIV in culture; whether Ciclopirox is effective for people carrying the virus, and how much might be needed to treat HIV-infected cells, is unknown. Per the researchers: "A drug-based drug discovery program, based on these compounds, is warranted to determine the potential of such agents in clinical trials of HIV-infected patients."

While Ciclopirox's existing status as an FDA-approved topical cream could enable it to be fast-tracked to human trials, but whether it's safe & effective in actual patients remains to be seen.

[PLOS ONE via SciAm]