N-acetylcysteine, Alpha-Lipoic Acid, L-Glutamine, and L-Carnitine - Nutrients and HIV, part 3

Alternative Medicine Review, August, 2000 by Lyn Patrick

Other antivirals classified as nucleoside reverse transcriptase inhibitors (ddI, ddC, d4T) also impair mitochondrial DNA production. This is believed to be the mechanism through which they produce axonal peripheral neuropathy, a common side-effect of these medications.[96] In a comparison study, patients on these medications with peripheral neuropathy were found to have significant acetyl-L-carnitine deficiencies when matched to patients on the same medications who did not develop neuropathy.[96] The authors stated that acetyl-L-carnitine is critical for peripheral nerve function and deficiencies may be contributing to the neurotoxicity of these medications. L-carnitine and acetyl-L-carnitine have been found to be protective for this type of mitochondrial damage in vitro,[97] and a clinical trial with acetyl-L-carnitine and peripheral neuropathy in HIV-negative patients has shown benefit.[98] In this study significant improvements in mobility, subjective and objective symptom rating, and performance were seen after one-gram intramuscular injections were given daily for 15 days.

Coenzyme Q

Coenzyme Q 10 (CoQ10) is present in all eukaryotic cells and all lipoproteins. Cellularly it acts as an electron carrier in the mitochondrial respiratory chain and as a free radical scavenger in liposomal membranes.[99] It appears to be as efficient as [Alpha]-tocopherol in preventing free peroxyl radical production in lipid membranes and prevents oxidation of [Alpha]-tocopherol in in vitro studies designed to mimic human physiological conditions. Reversal of depressed host defense systems in animals treated with chemotherapy has been achieved with administration of CoQ10[100] and CD4/CD8 ratios have been elevated as a result of increased CD4 counts in HIV-negative subjects on 100 mg CoQ10 daily for 60 days.[101]

CoQ deficiencies have been demonstrated in HIV infection.[100] The deficiencies (measured both in whole blood and intracellular erythrocytes and lymphocytes) in 12 HIV-infected individuals were significantly greater in symptomatic HIV-positive individuals than HIV-negative controls and COQ10 levels dropped with progressive stages of the infection.[100] CoQ10 at 200 mg daily was given to seven of these HIV-positive individuals. Three had AIDS diagnoses and four were symptomatic for AIDS-related complex (ARC): fever, night sweats, diarrhea, weight loss, and lymphadenopathy.[100] Treatment lengths varied in each case (4-14 months), but in all cases, whole blood CoQ10 levels rose substantially, as high as 4.51 mg/mL in one subject (mean levels in HIV-negative controls were 0.79 and 0.84 mg/mL). Five of the seven patients who were able to be followed improved symptomatically and had no opportunistic infections after 4-7 months.[100] A follow-up paper by the same author evaluated the effect of CoQ10 on two of the same HIV-positive ARC patients treated with CoQ10 for 4-5 years. Both had stabilized with remission of lymphadenopathy and no evidence of opportunistic infection. Information on concomitant antiviral regimens was not available.