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

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


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 distal symmetric peripheral neuropathy [1,2].

This topic will cover the pathogenesis, clinical manifestations, diagnosis, and treatment of distal symmetric peripheral neuropathy in HIV-infected patients.

The approach to peripheral neuropathy in general is discussed in detail elsewhere. (See "Approach to the patient with sensory loss" and "Overview of polyneuropathy".)


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].

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Literature review current through: Nov 2017. | This topic last updated: Oct 26, 2017.
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