The reverse transcriptase inhibitors lamivudine and zidovudine can cause damage to the mitochondria, the energy-producing subunits of cells. This may lead to symptoms such as lactic acidosis (a dangerous metabolic derangement), peripheral neuropathy (injury to nerves in the extremities), and lipodystrophy (cosmetically undesirable rearrangement of fat in the body). The supplement CoQ 10 has been tried for minimizing these side effects. In one double-blind, placebo-controlled study, use of CoQ 10 improved general sense of well-being in people with HIV infection using reverse transcriptase inhibitors; however, for reasons that are unclear, it actually worsened symptoms of peripheral neuropathy.1 For this reason, people with HIV who have peripheral neuropathy symptoms should use CoQ 10 only with caution.

Use of the herb St. John’s wort can lower blood levels of numerous medications, including protease inhibitors used for HIV. Case reports indicate St. John’s wort also lowers blood levels of the non-nucleoside reverse transcriptase inhibitor nevirapine.2 The bottom line: If you have HIV, do not take St. John's wort! Furthermore, if you have been stabilized on HIV medications while taking St. John's wort, if you stop taking the herb your blood levels of the drugs could rise, potentially leading to increased side effects.