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Diagnosis, treatment, and prognosis of HIV-associated neuropathies

Authors
Rachel A Nardin, MD
Roy Freeman, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Peripheral neuropathy is common in individuals infected with the human immunodeficiency virus (HIV). Peripheral neuropathy may arise as a complication of HIV infection itself, of drug therapy or of other host factors, such as diabetes.

The diagnosis, treatment, and prognosis of these neuropathic syndromes will be reviewed here. The epidemiology, pathogenesis, and clinical features of these disorders are discussed separately. (See "Epidemiology, pathogenesis, and clinical features of HIV-associated neuropathies".)

DIAGNOSIS

General approach — The diagnosis of peripheral neuropathy syndromes in HIV-infected patients is based upon the clinical picture, supported by electrodiagnostic studies including electromyography (EMG) and nerve conduction studies (NCS). Blood tests are frequently obtained to exclude other causes of neuropathy.

Lumbar puncture (LP) is not required for most patients but is indicated for any neuropathy associated with encephalopathy, constitutional symptoms (such as fever or weight loss), rapid symptom progression, or a history of lymphoma or CMV infection. It is also indicated in patients with specific clinical syndromes such as polyradiculopathy (see 'Lumbosacral polyradiculopathy' below) or suspected acquired inflammatory demyelinating polyradiculoneuropathy. (See 'Demyelinating polyradiculoneuropathy' below.)

The interpretation of cerebrospinal fluid (CSF) abnormalities in HIV-infected individuals must be done with caution because CSF abnormalities, especially elevated protein and pleocytosis, are common in HIV-infected patients including those who do not have peripheral neuropathy or are asymptomatic. In a large, population-based study of 875 largely asymptomatic, HIV-positive patients, 63 percent had at least one CSF abnormality, and 25 percent had three or four abnormalities; CSF abnormalities included elevated protein, cell count, IgG index, and oligoclonal bands [1]. There is no consistent relationship between nerve conduction and CSF findings [2]. However, total CSF protein values exceeding 1.2 g/L and cell counts exceeding 50/mm3 are unexpected in asymptomatic HIV infection and suggest clinical disease [1,3].

                         

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Literature review current through: Nov 2016. | This topic last updated: Tue Jun 23 00:00:00 GMT+00:00 2015.
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