title: Acetyl-l-carnitine in the treatment of painful antiretroviral toxic neuropathy in human immunodeficiency virus patients: an open label study.
abstract: Antiretroviral toxic neuropathy causes morbidity in human immunodeficiency virus (HIV) patients under dideoxynucleoside therapy, benefits only partially from medical therapy, and often leads to drug discontinuation. Proposed pathogeneses include a disorder of mitochondrial oxidative metabolism, eventually related to a reduction of mitochondrial DNA content, and interference with nerve growth factor activity. Carnitine is a substrate of energy production reactions in mitochondria and is involved in many anabolic reactions. Acetyl carnitine treatment promotes peripheral nerve regeneration and has neuroprotective properties and a direct analgesic role related to glutamatergic and cholinergic modulation. The aim of this study was to evaluate acetyl-l-carnitine in the treatment of painful antiretroviral toxic neuropathy in HIV patients. Twenty subjects affected by painful antiretroviral toxic neuropathy were treated with oral acetyl-l-carnitine at a dose of 2,000 mg/day for a 4-week period. Efficacy was evaluated by means of the modified Short Form McGill Pain Questionnaire with each item rated on an 11-point intensity scale at weekly intervals and by electromyography at baseline and final visit. Mean pain intensity score was significantly reduced during the study, changing from 7.35 +/- 1.98 (mean +/- SD) at baseline to 5.80 +/- 2.63 at week 4 (p = 0.0001). Electrophysiological parameters did not significantly change between baseline and week 4. In this study, acetyl-l-carnitine was effective and well tolerated in symptomatic treatment of painful neuropathy associated with antiretroviral toxicity. On the contrary, no effect was noted on neurophysiological parameters.
authors.affiliation: Clinica Neurologica, Università degli Studi di Milano, Milano, Italy. neurofisiologia@hsacco.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Osio
authors.forename: Francesco
authors.initials: F
authors.lastname: Muscia
authors.forename: Luisa
authors.initials: L
authors.lastname: Zampini
authors.forename: Caterina
authors.initials: C
authors.lastname: Nascimbene
authors.forename: Enrico
authors.initials: E
authors.lastname: Mailland
authors.forename: Antonietta
authors.initials: A
authors.lastname: Cargnel
authors.forename: Claudio
authors.initials: C
authors.lastname: Mariani
mesh_terms: D000108:Acetylcarnitine / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D010146:Pain / Q000188:drug therapy; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D014803:Vitamin B Complex; D000108:Acetylcarnitine