Discontinuing drugs

The most straightforward approach is to discontinue drugs that cause or worsen peripheral neuropathy. Dose reduction is also an option, but this may reduce antiviral potency. As it has become clear that the combination of ddI (didanosine, Videx/VidexEC) and d4T (stavudine, Zerit) is associated with a variety of side-effects, it is no longer considered a preferred combination for first-line therapy.

With improvements in antiretroviral treatment, there are now several alternatives that are similarly effective with less toxicity than the d-drugs. Five other nucleoside or nucleotide analogue reverse transcriptase inhibitors (NRTIs/NtRTIs) can be used to construct a NRTI backbone. Some treatment-experienced patients with extensive NRTI resistance may still need to use ddI or d4T, but if possible, they should avoid using both at once. Some experts have proposed ‘NRTI-sparing’ regimens that contain only non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors, but this approach remains experimental.

If neurotoxic drugs are discontinued when symptoms first emerge, neuropathy symptoms often improve dramatically or disappear completely after a several weeks. If the drugs have been used for an extended period, some nerve damage may be irreversible.