Thioctic acid, also known as alpha-lipoic acid, is a natural anti-oxidant which has been used for years in Europe because of it's ability to help maintain or restore liver health. It's strong anti-oxidant capabilities have been used for radiation sickness and diabetes-related neuropathy. It has also been investigated as a possible inhibitor of HIV. The PWA Health Group sells pharmaceutical grade thioctic acid without requiring a prescription.
Thioctic acid has been used successfully for the maintenance of liver health and as a treatment for several toxin-related illnesses. It may be a promising treatment for similar complications in HIV+ people. Thioctic acid has been used extensively in Europe for years as a non-toxic nutrient to treat various chemical overdoses such as mushroom poisoning, radiation poisoning and alcoholic hepatitis. It has also been used to treat diabetic neuropathy and elevated liver enzymes. Elevated liver enzymes, which can indicate liver damage, can be a serious problem for people with HIV. For people who take oral medications such as antibiotics and/or anti-virals, balanced liver enzymes are essential for these drugs to get metabolized properly. Unfortunately, these same drugs can cause increased liver enzymes. Thioctic acid may help protect the liver so that you can take antibiotics without raising liver enzymes, or may be used to bring enzymes down so that you can start certain drugs. A second benefit of thioctic acid may be its ability to elevate the level of glutathione (GSH) and reactive oxidants in PWAs. As we have learned from trials of thioctic acid's fellow anti-oxidant NAC , naturally-occurring anti-oxidants (GSH, plasma ascorbate, plasma thiol, etc.) are often low in PWAs. This lack may cause oxidative stress, and cause inflammation and damage organs. It may also damage nerve cells, leading to peripheral neuropathy. Oxidative stress may also speed up the replication of HIV.
While there have been several clinical trials of thioctic acid, most of them did not involve PWAs. However, these trials may help us understand what thioctic acid does, and how it may be of benefit to us. A1993 placebo-controlled trial concluded that thioctic acid was effective in reducing oxidative stress in people with diabetes. 80 people were randomized to either placebo or one of three antioxidants. These included: thioctic acid (600 mg), selenium (100mg), or vitamin E (1200 IE). Everyone on the antioxidants reported a reduction in oxidative stress, including reduced neuropathy and organ inflammation. There was no reported statistical difference between the antioxidants.
There has been one clinical trial of thioctic acid in PWAs. In a German pilot study, 10 people took 300 mg/day of thioctic acid for 8 weeks. After 8 weeks, glutathione was increased substantially in 7 PWAs, and CD4/CD8 cells were increased in 6 PWAs. There is currently a second trial open in Germany, attempting to enroll 30 PWAs to study the possible use of thioctic acid in treating PWAs with peripheral neuropathy.
We know that side effects are minimal when taken at the doses used in clinical trials. Due to the limited number of studies with PWAs, we really don't know much about possible side effects. In studies involving HIV-negative volunteers, decreased blood platelets (thrombocytopenia) and nausea were reported by those taking higher doses of thioctic acid (900 mg). However, the data singling out thioctic acid as the cause of these effects are unsubstantiated. Like most antioxidants, thioctic acid is a chelating agent, and can purge minerals from your body. In one study of thioctic acid in HIV-negative volunteers, the amount of iron in their blood was shown to decrease significantly. This depletion can often lead to anemia. You and your doctor should monitor iron levels with regular blood tests.
We're not sure what's the best dose to take, or if different doses would be used for liver enzymes compared to neuropathy. We know from trials and anecdotal reports that people are taking anywhere from 200 mg/day to 600 mg/day. Only a large trial of thioctic acid that measures the efficacy and side effects with different dosages will clarify what's best.
The PWA Health Group imports pharmaceutical grade thioctic acid (Thioctacid 300) made by ASTA Medica AG in Germany. While it can be found in some health food stores, the quality of health food-brand thioctic acid is not guaranteed. One bottle of Thioctacid contains sixty 300 mg tablets. According the doses recommended above, one bottle will last anywhere from 1-2 months.