Twenty-one HIV-infected patients (median age, 40 years) with toxic neuropathy induced by antiretroviral drugs received 1,500 mg of acetyl L-carnitine (ALC) twice a day for a median duration of 14 months (range, five to 33 months). After six months of treatment, histological evidence of nerve regeneration was seen; these improvements continued (epidermis and dermis) or stabilized (sweat glands) after 24 months of treatment. The neuropathy improved in 76% of the patients and remained stable in an additional 19%.
Comment by Alan R. Gaby, MD
Nucleoside analogue reverse transcriptase inhibitors (NRTI) such as stavudine, zalcitabine, and didanosine, which are used to treat HIV infection, disrupt neuronal mitochondrial DNA synthesis, impairing energy metabolism and resulting in a toxic neuropathy that causes significant morbidity. Serum Acetyl L-Carnitine levels are decreased in patients with neuropathy associated with NRTI therapy. The results of the present study suggest that ALC treatment can improve symptoms and promote peripheral nerve regeneration in HIV-infected patients with drug-induced neuropathy.
Hart AM, et al. Acetyl-l-carnitine: a pathogenesis-based treatment for HIV-associated antiretroviral toxic neuropathy. AIDS. 2004;18:1549-60.
Reported by Alan R. Gaby, MD in Townsend Letter for Doctors and Patients - June 2006. Reprinted with exclusive permission.