ABSTRACT
BACKGROUND: Nucleoside analogue reverse transcriptase inhibitors (NRTI) disrupt neuronal mitochondrial DNA synthesis, impairing energy metabolism and resulting in a distal symmetrical polyneuropathy (DSP), an antiretroviral toxic neuropathy (ATN) that causes significant morbidity in HIV disease. Serum acetyl-l-carnitine (ALCAR) levels are decreased in neuropathy associated with NRTI therapy. ALCAR enhances neurotrophic support of sensory neurons and promotes energy metabolism, potentially causing nerve regeneration and symptom relief. OBJECTIVE: To assess the efficacy of oral ALCAR (1500 mg twice daily) for up to 33 months in an open cohort of 21 HIV-positive patients with established ATN. METHODS: Skin biopsies were excised from the leg before ALCAR treatment, at 6-12 month intervals thereafter and from HIV-negative non-neuropathic controls. Fibre types in epidermal, dermal and sweat gland innervation were quantified immunohistochemically. RESULTS: After 6 month's treatment, mean immunostaining area for small sensory fibres increased (epidermis 100%, P = 0.006; dermis 133%, P < 0.05) by more than that for all fibre types (epidermis 16%, P = 0.04; dermis 49%, P < 0.05; sweat glands 60%, P < 0.001) or for sympathetic fibres (sweat glands 41%, P < 0.0003). Compared with controls, epidermal, dermal and sweat gland innervation reached 92%, 80% and 69%, respectively, after 6 month's treatment. Innervation improvements continued (epidermis and dermis) or stabilized (sweat glands) after 24 month's treatment. Neuropathic grade improved in 76% of patients and remained unchanged in 19%. HIV RNA load, CD4 and CD8 cell counts did not alter significantly throughout the study. CONCLUSIONS: ALCAR treatment improves symptoms, causes peripheral nerve regeneration and is proposed as a pathogenesis-based treatment for DSP.
Subject(s)
Acetylcarnitine/therapeutic use , HIV Infections/drug therapy , HIV Reverse Transcriptase/antagonists & inhibitors , HIV-1 , Nootropic Agents/therapeutic use , Peripheral Nervous System Diseases/drug therapy , Reverse Transcriptase Inhibitors/adverse effects , Adult , Cohort Studies , Female , Humans , Male , Middle Aged , Nerve Regeneration/drug effects , Peripheral Nervous System Diseases/chemically inducedABSTRACT
223 pacientes epiléptico e suas famílias e 136 professores da rede pública e privada foram submetidos a questionários similares que incluíam questöes relacionadas à hereditariedade, transmissibilidade, cura, complicaçöes, cuidados durante as crises, necessidade de informaçöes acerca da doença, Hábitos, comparaçöes com outras doenças e performances sociais e educacionais de epilépticos. Taxas presumidas de cura e complicaçöes representaram a maior diferença entre as duas populacöes. Epilépticos reconhecem um maior número de complicaçöes mas persistem acreditando na cura de sua moléstia. A maioria dos professores e pacientes jamais havia recebido qualquer informaçäo sobre epilepsia e isto possivelmente relacicona-se às respostas equívocas que foram obtidas. Em suma, os dados sugerem que as performances sociais e educacionais de pacientes epilépticos podem ser modificadas por parâmetros médicos e sociais, alguns dos quais podem ser melhorados através de um programa educacional direcionado aos aspectos sociais das epilepsias
