Neuropathy Update

Issue #121 of AIDS TREATMENT NEWS contained a short overview of possible treatments for HIV-related peripheral neuropathy, with a call for our readers to share their experience with us. Two people did so, and we relay that information below, as well as some brief news regarding neuropathy presented at the Seventh International Conference on AIDS in Florence.

A number of studies of peripheral neuropathy were discussed at Florence, but most of them dealt with laboratory descriptions of cell pathology more than treatment for neuropathy. An Italian study from the University of Pavia described the development of neuropathy in patients after treatment with AZT (abstract # M. B. 2115). AZT is already associated with muscle tissue damage, or myopathy, after prolonged use in some people.

Preliminary results of the California mexiletine study that we mentioned in our last neuropathy report were included in the Conference abstracts. The authors state that mexiletine has been well-tolerated in the study participants, but proof of efficacy is not yet established (abstract # M. B. 2068).

After our last report on neuropathy, one friend of the newsletter called to say that had he obtained substantial relief with chiropractic treatments. His neuropathy was apparently caused not by HIV but by a three-week regimen of intravenous pentamidine. Following the pentamidine he experienced a severe, chronic pain in one arm which was diagnosed by his primary physician as neuropathy. Our friend sought the attention of an HIV-knowledgeable chiropractor, who initiated weekly treatments. Within ten treatments he noticed nearly complete relief from the neuropathy. (Drug-induced neuropathy can often resolve itself if the problem drug is discontinued or reduced in dosage soon enough.)

Jeanne Day of the Community Research Initiative of New England told us that they are conducting a study of acupuncture to treat HIV-associated neuropathy. This study, funded by the American Foundation for AIDS Research (AmFAR), began recruiting last November and is still open to new participants.

Ms. Day said that although it is too early to report the results of formal neurological assessments, the acupuncturists administering the treatments are optimistic with their patients' progress so far. People interested in the study can call 617/424-1524. Incidentally, a very good general discussion of acupuncture therapy in HIV infection appeared in the May 15, 1991, edition of Treatment Issues, published by the Gay Men's Health Crisis in New York.

Fortunately, many of the drugs now tried experimentally to relieve neuropathy, including nortriptyline, imipramine, mexiletine, and topical preparations of capsaicin, are already approved for other indications and so are available for the cost of a prescription. But looking for conceptually new options in established forums like the International AIDS Conferences can be unrewarding. Sustainable, low-cost treatment possibilities like acupuncture represent an innovative direction in AIDS research, but will probably require community interest and community-based organizations to do the research which is necessary.