HIV-RELATED PERIPHERAL NEUROPATHY: PAIN TREATMENT WITH DRUGS AND ACUPUNCTURE

L. Zampini, A. Casella, MC Banfi, L. Valsecchi, C. Gervasoni §, F. Niero*, M. Osio**, R. Gatto°, A. Cargnel.
II Inf. Dis. Div., § Clin. Inf. Dis., * I Inf. Dis. Div., **Neurological Clinic A.O.L. Sacco, Milan, °S.I.A. Milan

 Objective:

Confrontation of effectiveness and tolerance of four different therapeutic approaches in HIV-related peripheral neuropathy pain control and evaluation of possible neurophysiological markers for a monitoring of neurological peripheral pathology or treatment selection. From august 1997 to august 1998, 28 HIV positive patients with rheumatic pain and electromyographical diagnosis of distal symmetric neuropathy have been recruited. Drugs, for 30 days individually used according to a randomized succession order, have been: mexiletina (MX), L-acetilcarnitina (L-AC) and amitriptilina (AT); 7 fixed acupoints have been choose according to classic Chinese diagnostics criteria (two seats per week per 5 weeks). 20 patients completed whole protocol; so we considered only results related to their treatment cycles.

Results:

Drugs collateral effects resulted in light intensity and they don't involved suspension except for one case (gastrointestinal disturbs with mexiletina). Data analysis don't showed major effectiveness than other. We evidenced from statistical analysis (t-Student and correlation coefficient) that L-AC and MX reduce pain above all in neuropathy with basal neurophysiological characteristics of assonal or mixed assonal-demyelinizing (p<0.004) and that such L-AC effectiveness is directly proportional to CD4+ count (p<0.01) and to speed value of motor peroneal nerve conduction (p<0.01) and tibial (p<0.03). AT effectiveness therapy is directly related to peroneal nerve speed conduction (p<0.028). Pz with prevalently demyelinizing neuropathy had a better answer without acupuncture treatment; effectiveness results inversely proportional to sureal nerve potential sensitive high (p<0.03) and directly related to tibial nerve F wave latency (p<0.016). No relation showed between viral load and treatments effectiveness; any treatment determined a meaningful treatment of neurophysiological gathered data.

Conclusions:

L-AC seems to be the most effective treatment in initial states of assonal neuropathy with cellular immunity relatively conserved; acupuncture is the most effective in prevalently demyelizing shapes, with more heavy signs of proximal involvement of spinal nerve.