Long-term effect of acetyl-L-carnitine for antiretroviral toxic neuropathy.
BACKGROUND
Nucleoside analogue reverse transcriptase inhibitors (NRTIs) used for the treatment of HIV can a cause distal symmetrical peripheral polyneuropathy by disruption of mitochondrial metabolism. Treatment with acetyl-L-carnitine (ALCAR) has shown short-term symptomatic and histological improvement. Long-term effects have not been investigated.


OBJECTIVE
To assess the subjective and objective degree of antiretroviral toxic neuropathy (ATN) during treatment with ALCAR.


METHODS
A cohort of 21 patients with ATN who commenced treatment with ALCAR between March 1999 and October 2001 was reviewed after a mean of 4.3 years using standardized questionnaires and neurological examination.


RESULTS
Of the 21 patients, 2 had died and 3 were lost to follow-up. 16 patients were assessed. 10 were still on potentially neurotoxic drugs. 13 were still taking ALCAR. 9 were pain free. The most common symptom was numbness (mild, moderate, and severe in 12, 3, and 0 patients, respectively), followed by paraesthesia (8, 2, 2), pain (4, 3, 0), and burning (5, 2, 0). There was mildly reduced sensation in the toes of 8 patients. 13 patients reported that ALCAR had improved their symptoms very much or moderately, 2 reported no change, and 1 reported a moderate worsening.


CONCLUSIONS
ALCAR led to long-term symptomatic improvement in most patients without the need to discontinue neurotoxic drugs. Although in this study there was no control group, this agent appears to be an effective pathogenesis-based treatment for ATN.
Royal Free Centre for HIV Medicine, Royal Free Hospital, London, United Kingdom. christian.herzmann@web.de
Christian
C
Herzmann
Margaret A
MA
Johnson
Mike
M
Youle
D000108:Acetylcarnitine / Q000627:therapeutic use*; D015331:Cohort Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000254:growth & development*; D006801:Humans; D006987:Hypesthesia / Q000188:drug therapy; D018697:Nootropic Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000188:drug therapy*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use
D018697:Nootropic Agents; D018894:Reverse Transcriptase Inhibitors; D000108:Acetylcarnitine