Long-term effect of acetyl-L-carnitine for antiretroviral toxic neuropathy

HIV Clin Trials. Nov-Dec 2005;6(6):344-50. doi: 10.1310/CH1N-YBNU-G3CU-JBXR.


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.

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

Method: 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcarnitine / therapeutic use*
  • Cohort Studies
  • Follow-Up Studies
  • HIV Infections / drug therapy*
  • HIV-1 / growth & development*
  • Humans
  • Hypesthesia / drug therapy
  • Nootropic Agents / therapeutic use*
  • Pain / drug therapy
  • Peripheral Nervous System Diseases / chemically induced*
  • Peripheral Nervous System Diseases / drug therapy*
  • Reverse Transcriptase Inhibitors / adverse effects*
  • Reverse Transcriptase Inhibitors / therapeutic use


  • Nootropic Agents
  • Reverse Transcriptase Inhibitors
  • Acetylcarnitine