Didanosine is a drug that blocks reproduction of the human immunodeficiency virus (HIV). HIV is the virus that infects people causing acquired immunodeficiency syndrome (AIDS). Didanosine is used in combination with other drugs to treat HIV infection.
Persons with AIDS have developed lactic acidosis and fatty liver while taking didanosine and other drugs in its class. Didanosine can inhibit crucial DNA-related riboflavin activity, which may be normalized by riboflavin supplementation. A 46-year-old woman with AIDS and lactic acidosis received a single dose of 50 mg of riboflavin, after which her laboratory tests returned to normal and her lactic acidosis was completely resolved.1 More research is needed to confirm the value of riboflavin for preventing and treating this side effect.
Lentinan is a complex sugar found in shiitake mushrooms (Lentinas edodes) and is recognized as an immune modulator. In an early human trial, 88 HIV-infected people received didanosine (400 mg per day) plus a 2 mg lentinan injection per week.2 Didanosine-lentinan combination therapy improved CD4 immune cell counts for a significantly longer period than didanosine alone. Lentinan is under investigation as an adjunct therapy to be used with didanosine for HIV infection.3 Oral preparations of shiitake are available, but it is not known if they would be an effective treatment with didanosine for HIV infection.
Severe peripheral neuropathy (painful sensations due to nerve damage in the hands and feet) often develops in people taking didanosine or other drugs in its class. People with peripheral neuropathy who were taking one of these drugs were found to be deficient in acetyl-L-carnitine.4 In a preliminary trial, supplementation with 1,500 mg of acetyl-L-carnitine twice a day resulted in improvement in the neuropathy after six months in people taking didanosine or related drugs.5 Similar benefits were seen in another study that used the same amount of acetyl-L-carnitine.6
1. Fouty B, Frerman F, Reves R. Riboflavin to treat nucleoside analogue-induced lactic acidosis. Lancet 1998;352:291–2 [letter].
2. Gordon M, Guralnik M, Kaneko Y, et al. A phase II controlled study of a combination of the immune modulator, lentinan, with didanosine (ddI) in HIV patients with CD4 cells of 200–500/mm3. J Med 1995;26:193–207.
3. Threlkeld DS, ed. News, Keeping Up, December 1994, Lentinan. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Dec 1997, 805.
4. Famularo G, Moretti S, Marcellini S, et al. Acetyl-carnitine deficiency in AIDS patients with neurotoxicity on treatment with antiretroviral nucleoside analogues. AIDS 1997;11:185–90.
5. Hart AM, Wilson AD, Montovani C, et al. Acetyl-l-carnitine: a pathogenesis based treatment for HIV-associated antiretroviral toxic neuropathy. AIDS2004;18:1549–60.
6. Herzmann C, Johnson MA, Youle M. Long-term effect of acetyl-L-carnitine for antiretroviral toxic neuropathy. HIV Clin Trials 2005;6:344–50.
Last Review: 11-07-2012
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