HIV JournalView

Table of Contents

• An Alternative for Peripheral Neuropathy
• Stable Viral Load but Evolving Drug Resistance
• Niacin Revisited
• HIV on Campus
• References

An Alternative for Peripheral Neuropathy

Hart AM, Wilson ADH, Montovani C, et al. Acetyl-l-carnitine: a pathogenesis based treatment for HIV-associated antiretroviral toxic neuropathy. AIDS. July 23, 2004;18(11):1549-1560.

It is difficult to imagine: pain with every step, lying awake in bed, feet on fire, a tingling numbness that doesn't allow you to think of anything else. Painful distal peripheral neuropathy (PN) is a particularly insidious adverse effect of certain HIV therapies, and a common complaint in clinical practice.

To a great extent, the incidence of antiretroviral-related PN has been pegged to the popularity of the deoxynucleotide analogue agents -- stavudine (d4T, Zerit), didanosine (ddI, Videx) and zalcitabine (ddC, Hivid); as use of these agents has waned, so too has the incidence of drug-associated PN. However, for various reasons, some patients still require these antiretrovirals. Therapy for painful PN has had limited success and there are no licensed effective therapies to date. Once the cornerstone of therapy, tricyclic antidepressants have given way to anticonvulsants such as gabapentin (Neurontin) and lamotrigine (Lamictal). Yet, for many PN sufferers, these agents -- even in combination with narcotic analgesics -- provide less than complete relief and add additional pill burden to standard HIV regimens. Withdrawal of the offending antiretroviral is often possible, although, in some cases, there is the risk of loss of control of HIV viremia. Further, the heavy reliance on stavudine in the developing world insures that PN may become a major issue in the management of HIV in these areas. Therefore, an effective therapy for relief of antiretroviral-associated PN remains an important priority.

...

Want to read the rest of this article? To learn more about our audience, we're asking readers to register in order to receive full access to all of our materials. Please click here to begin your quick, free registration at The Body PRO.

If you're already registered with The Body PRO, please log in:

E-mail Address
Password
	Remember my login

Forgot your password?