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286 Neuropathy – HIV related
3600 mg/day); a high (80%) somnolence rate was also seen. 5 Evidence from
other trials also supports utility of gabapentin for HIVNP. 6
Neurotoxic neuropathic pain (i.e. that from antiviral agents) is improved
by treatment with the neurotrophic support drug acetyl-L-carnitine (500 mg
IM BID). 4–6
An RCT assessing use of cannabis cigarettes found this approach – not
realistic for the acute care setting – reduced pain compared with placebo. 7
Anonymous questionnaires suggest that cannabis reduces HIVNP in up to
90% of respondents. 8
Multicenter RCT evidence demonstrated lack of utility of the N-methyl-Daspartate
(NMDA) antagonist memantine for HIVNP. 9
Although intravenous immunoglobulin (IVIG) is often used for treating
HIVNP, critical reviews of available data reveal insufficient evidence to support
a recommendation for its acute care administration for this indication. 10,11
Topical therapy with capsaicin is recommended for HIVNP by some
editorialists and expert reviews. 12,13 However, Cochrane review of the available
evidence concluded that there are no data supporting use of capsaicin
for HIVNP. 14,15
Data from RCT also demonstrated failure of topical lidocaine (5% gel) in
treatment of HIVNP. 16
The antineoplastic agent thalidomide has been used for HIVNP, but its
known toxicity outweighs any evidence-supported benefit for its use in this
condition. 17
n Summary and recommendations
First line: gabapentin (300 mg PO HS on day 1; 300 mg PO BID on day 2;
300 mg PO TID thereafter with up-titration as needed, to 1800 mg/day
maximum)
Reasonable: if HIVNP is from toxic antiviral drugs, acetyl-L-carnitine (500 mg
IM BID)
Pregnancy: weighing risks and benefits of gabapentin, lamotrigine, and
acetyl-L-carnitine therapy during pregnancy may result in a decision to