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Epidemiology, clinical manifestations, diagnosis, and treatment of HIV-associated peripheral neuropathy

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

INTRODUCTION

There are a number of distinctive neuropathic syndromes, which can be classified according to the timing of their appearance during HIV infection, their etiology, and whether they are primarily axonal or demyelinating. The most common of these is peripheral neuropathy, also referred to as distal symmetric peripheral neuropathy [1,2].

This topic will cover the pathogenesis, clinical manifestations, diagnosis, and treatment of distal symmetric peripheral neuropathy. The clinical manifestations of other HIV-associated neuropathies (eg, acquired inflammatory demyelinating polyradiculoneuropathy, cauda equina syndrome, diffuse infiltrative lymphocytosis syndrome (DILS), autonomic neuropathy, mononeuropathies, herpes zoster neuropathy, sensory ganglioneuritis) are discussed elsewhere. (See "Epidemiology, pathogenesis, and clinical features of HIV-associated neuropathies".)

EPIDEMIOLOGY

The prevalence of distal symmetrical polyneuropathy (DSPN) in different series has varied from 9 to 63 percent [3-8]. This variability reflects differences in the degree of immunosuppression (higher prevalence with more advanced disease), in the definition of the neuropathy (symptomatic or asymptomatic), and in exposure to neurotoxic antiretrovirals [4,9,10]. Because of known neurotoxicities, didanosine and stavudine are no longer recommended for the treatment of HIV. (See "Selecting antiretroviral regimens for the treatment-naïve HIV-infected patient".)

Risk factors — In the era prior to potent antiretroviral therapy (ART), DSPN usually occurred in the setting of advanced immunosuppression [3,9,11-13]. In one report, for example, the mean CD4 count was 113/microL (range 26 to 275 cells/microL) [9].

In addition to immunosuppression, the level of HIV viremia was also correlated with the development of DSPN and the severity of symptoms [5,14,15]. In the Multicenter AIDS Cohort Study, the risk of DSPN was increased 2.3-fold in patients with an HIV RNA level >10,000 copies/mL at baseline [14].

                     

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Literature review current through: Nov 2016. | This topic last updated: Fri May 15 00:00:00 GMT 2015.
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