HIV Antiretrovirals (NRTIs)
Common brand names: Truvada, Descovy, Biktarvy, Genvoya, Atripla, Viread
Three nutrients listed against this medication. The most severe is marked critical.
At a glance
None of the three is marked well documented. Each row carries its own evidence level.
At a glance
- Carnitine (L-Carnitine)Critical · Moderate evidence
- CoQ10Moderate · Mechanism only, no human trial
- Vitamin D3Moderate · Moderate evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, NRTIs inhibit mitochondrial DNA polymerase gamma, causing mitochondrial toxicity and depleting CoQ10. This is the mechanism behind NRTI-induced lipodystrophy, peripheral neuropathy, and lactic acidosis.
Common signs, Peripheral neuropathy, fatigue, lipodystrophy, lactic acidosis risk, muscle wasting
Chen et al. (Cardiovascular Toxicology, 2019; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 31020509): coenzyme Q10 alleviated NRTI-induced premature endothelial senescence in a preclinical model. Cell and animal work. No human trial has measured a CoQ10 deficit in people taking NRTIs.
Trials in NRTI-treated people have used CoQ10 at 200 to 400 mg daily. The evidence behind the NRTI-CoQ10 link is preclinical: no human trial has measured a CoQ10 deficit in people taking NRTIs.
Mechanism, NRTIs impair carnitine biosynthesis and transport. Carnitine is required to shuttle long-chain fatty acids into mitochondria. NRTI-induced carnitine deficiency causes peripheral neuropathy and myopathy.
Common signs, Peripheral neuropathy (painful), myopathy, cardiac dysfunction, fatigue, cognitive impairment
Famularo et al. (AIDS, 1997; PMID 9030365): acetyl-carnitine levels were measured in patients who developed axonal peripheral neuropathy on nucleoside analogues and were found deficient. This is a cross-sectional measurement, not a trial of reversal.
Acetyl-L-carnitine was used at 1,000–2,000 mg daily and is favored for neuropathy since it crosses the blood-brain barrier; this is discussed with the HIV specialist.
Mechanism, HIV infection, tenofovir-based renal tubular effects, and antiretroviral-induced bone loss all converge on Vitamin D deficiency. Tenofovir specifically causes renal phosphate wasting and bone demineralization.
Common signs, Bone loss, osteoporosis, muscle weakness, immune suppression
Cook et al. (South Med J, 2016; PMID 27812717): in a randomized pilot, an efavirenz/tenofovir regimen produced sustained reductions in 25(OH)D and hip BMD not seen with a raltegravir-based regimen.
Vitamin D3 2,000–4,000 IU plus K2 daily was used, with quarterly testing, and is of particular importance with tenofovir-based regimens.
For your next appointment
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Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →