Acetyl-l-carnitine and nucleoside reverse transcriptase inhibitor-associated neuropathy in HIV infection

Objectives—Antiretroviral Toxic Neuropathy is associated with dideoxy-nucleoside reverse transcriptase inhibitor use in HIV, possibly due to mitochondrial toxicity. Acetyl-L-Carnitine (ALC) has been linked to symptomatic improvement in ATN. We present an open-label single-arm pilot study to evaluate change in intra-epidermal nerve fiber (IENF) density and mitochondrial DNA (mtDNA) copies/cell among subjects treated with 3000mg ALC daily. Methods—Punch skin biopsies were examined at baseline and 24 weeks after therapy. Participants reported neuropathic symptoms using the Gracely Pain Intensity Score. Neurological examinations were completed. Results—Twenty-one subjects completed the study. ALC was generally well-tolerated. The IENF density did not change among cases completing 24 weeks of ALC therapy, with median (90% confidence interval (CI)) IENF changes of −1.70 (−3.50, ∞), p=0.98 and 2.15 (−0.10, ∞), p=0.11 for the distal leg and proximal thigh, respectively. Fat mtDNA copies/cell did not change with therapy. Improvements in neuropathic pain (p