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Neuropathy – HIV related
DAVID CLINE AND STEPHEN H. THOMAS
n Agents
n Antidepressants
n Anticonvulsants
n Acetyl-L-carnitine
n Cannibis
n Memantine
n Intravenous immunoglobulin
n Capsaicin
n Lidocaine
n Thalidomide
n Evidence
Neuropathy is common in patients infected with HIV. Unfortunately, HIVrelated
neuropathy (HIVNP) is resistant to many of the drugs that are generally
helpful in neuropathic conditions. Cochrane review has found, for
instance, that antidepressants are ineffective for treating HIVNP. 1
Data are mixed with respect to use of the anticonvulsant lamotrigine
(titrated to 600 mg PO daily) in HIVNP. It appears that lamotrigine reduces
HIVNP, but only in patients who are also receiving neurotoxic antiretroviral
drugs (didanosine, zalcitabine, or stavudine). 2 Cochrane review of the literature
addressing lamotrigine in HIVNP concluded that there is insufficient
evidence to support recommendation for its routine use. 3
Available evidence on the utility of gabapentin for HIVNP is conflicting. A
large trial of various types of neuropathy demonstrated relief with gabapentin
in the overall study population but failed to reveal utility of the drug in
subgroup analysis of patients with HIVNP. 4 Conversely, a small RCT (n = 29)
focusing on HIVNP reported effective pain relief with gabapentin (2400 to
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