Meta-analysis of RCTs support use of smoked cannabis to treat HIV-related peripheral neuropathy

A review of evidence from randomised clinical trials for pharmacological interventions to manage HIV-related painful sensory neuropathy was published in December 2010 in PLoS One (free online access).

This meta-analysis primarily highlighted the limited research on treatments for HIV-related sensory neuropathy (SN). Studies for some potentially active compounds involve small patient numbers and non-standardised methodology. This remains a major area of neglect given that this paper references evidence for rates of neuropathy of around 40% (in patients not exposed to d-drugs) and up to 60% in resource-limited settings where use of d4T is still standard of care.

Of note, pharmacological interventions that showed benefits in pain relief compared to placebo in randomised clinical trials were only found for smoked cannabis, recombinant human Nerve Growth Factor (rhNGF) and high dose (8%) topical capsaicin.

In the context of HIV-related neuropathy, this analysis failed to find evidence for use of amitriptyline, pregabalin, and gabapentin that are currently recommended in NICE guidelines for treating neuropathy pain management in the non-specific setting.

There has always been a demand for the decision to discontinue research into rhNGF by Genentech, now a subsidiary of Hoffman-La Roche, to be reexamined and the review concludes Gene microarrays have been used to identify novel drug targets. Ongoing evaluation of both novel analgesics and existing untested strategies for HIV-SN is a clear research priority.