Other than stopping neuropathy-causing drugs—which isn't always possible for people with limited HIV treatment options or in need of other medications for certain illnesses—managing peripheral neuropathy can be a challenge. A number of treatments have been used over the years, and are still prescribed, to treat the painful symptoms of peripheral neuropathy (reviewed in the next section). What has been missing, however, are treatments that reverse the underlying cause of neuropathy symptoms, notably the mitochondrial damage that can lead to nerve problems. Fortunately, some research progress has been made in recent years.
To reverse mitochondrial damage caused by NRTIs in people with peripheral neuropathy, at least two widely available supplements are being studied in clinical trials. The first is acetyl-L-carnitine, believed to improve the function of cellular mitochondria through its ability to transport fatty acids. In a study conducted at the Royal Free and University College Medical School in London and published in 2004, 21 HIV-positive people with NRTI-associated peripheral neuropathy were treated with 1,500mg twice-daily doses of acetyl-L-carnitine for up to 33 months. After six months of treatment, biopsies taken from the patients—and compared to those taken from HIV-negative study volunteers—found significant regrowth in nerves of the skin. Sixteen (76%) patients also reported symptom improvements during the study period.
In another study, reported in 1997, 500 to 1,000mg daily acetyl-L-carnitine reduce neuropathy symptoms in 10 of 16 (63%) HIV-positive patients with peripheral neuropathy. Unfortunately, biopsies were not conducted to measure nerve growth in this study. A third study using a combination of supplements that included acetyl-L-carnitine did not appear to reverse symptoms of peripheral neuropathy or improve neurological tests in HIV-positive people with this side effect.
Uridine, sold in the U.S. as NucleomaxX and in Europe as Mitocnol, is another supplement that may help improve mitochondrial function. Encouraging data using uridine in clinical trials involving people with diabetic neuropathy have been reported. Studies of uridine involving HIV-positive people with neuropathy are being conducted.
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