Abstract
A woman with a seventeen-year history of HIV infection on effective antiretroviral therapy presented with signs and symptoms of distal symmetric polyneuropathy (DSP). She developed significant side effects (dizziness, nausea, edema) with medications for pain management. Chart review revealed a history of similar intolerance to multiple antiretrovirals, which was not explained by known cardiac or gastrointestinal disease or psychological factors. Specialized testing revealed the presence of an autonomic neuropathy, which provided an explanation for her medication intolerance. The patient was educated on the symptoms of autonomic neuropathy and its relationship to DSP and subsequent symptomatic medications were initiated at the lowest possible doses. Although symptom management remained challenging, the patient exhibited lower frustration and greater acceptance of medication trials. Review of 168 advanced stage HIV infected individuals demonstrated that 81% experienced at least one, and 33% three or more, symptoms potentially attributable to autonomic neuropathy. Potentially autonomic symptoms were significantly associated with the presence of symptomatic DSP. Autonomic neuropathy is difficult to diagnose without specialized testing, as its symptoms are non-specific and overlap with a large number of somatic disorders. The high prevalence of autonomic-type symptoms in chronic HIV, and their association with peripheral neuropathy, may warrant further investigation of the potential for autonomic dysfunction in individuals with HIV-related symptomatic DSP.
Highlights
HIV-associated distal symmetric polyneuropathy (HIVDSP) is a common complication of HIV, and its symptoms include pain, paresthesias and numbness, usually beginning symmetrically in the feet [1,2]
We review potentially autonomic symptoms and their relationship to HIV-DSP in 168 patients followed by the Manhattan HIV Brain Bank, a longitudinal study of advanced-stage, chronically HIV-infected individuals with high prevalence of antiretroviral therapy and HIV-DSP
There is very little awareness that HIV-DSP may be accompanied by autonomic neuropathy, as exemplified by our case report
Summary
HIV-associated distal symmetric polyneuropathy (HIVDSP) is a common complication of HIV, and its symptoms include pain, paresthesias and numbness, usually beginning symmetrically in the feet [1,2]. Symptoms of autonomic neuropathy such as orthostatic dizziness or fainting, nausea or vomiting especially with meals, diarrhea and/or constipation, urinary incontinence, sexual dysfunction, and changes in sweating, are not typically thought of as part of the HIVDSP symptom complex. These symptoms seldom elicit a diagnostic work up for autonomic dysfunction, as they are thought to more commonly be aspects of systemic illnesses or medication intolerance occurring in the context of HIV. We review potentially autonomic symptoms and their relationship to HIV-DSP in 168 patients followed by the Manhattan HIV Brain Bank, a longitudinal study of advanced-stage, chronically HIV-infected individuals with high prevalence of antiretroviral therapy and HIV-DSP
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