Role of nutritional supplements

There is considerable interest in L-acetyl carnitine (LAC) as a treatment for neuropathy associated with the NRTIs ddI and d4T. LAC is a natural amino acid that is related to L-carnitine. A recent study has shown that LAC can reverse the loss of nerve fibres from the skin and improve the symptoms of peripheral neuropathy after six months of treatment.¹ A two-month randomised study found that 14 days of intramuscular LAC followed by oral treatment reduced reported pain.²

The mechanism of action of this treatment is not known, although it may reduce mitochondrial DNA damage by a direct antioxidant effect, or by promoting the metabolism of fatty acids and glucose.

Research into diabetic neuropathy has suggested that supplements of linolenic acid (GLA), lipoic acid, magnesium and chromium may help relieve pain due to neuropathy, although few of these supplements have been tested among people with HIV-related neuropathy. Supplementation with vitamins B₁ and B₂ has also been explored as a way of relieving symptoms of mitochondrial toxicity. There is anecdotal evidence that nutrients may prevent the onset of neuropathy among people with HIV, although this has not been proven in clinical trials.³

Vitamin B₁₂ deficiency is a cause of neuropathy and many people with HIV have such a deficiency, which may cause symptoms such as fatigue, poor memory and low levels of red blood cells. A full B complex supplement may be taken to relieve vitamin B₁₂ deficiency although overdosing of vitamin B₆ may cause nerve damage.