Peripheral neuropathy in HIV disease.

Abstract

Neurologic disorders are among the most common and devastating complications of HIV infection and AIDS.1 As patients with HIV infection survive longer in the era of HAART, it is likely that the prevalence of these disorders will increase. Peripheral nerve disorders are the most common neurologic complication of HIV disease.2 HIV-related peripheral nerve disorders include distal symmetric polyneuropathy (DSP), acute or chronic inflammatory demyelinating polyneuropathy (IDP), mononeuritis multiplex (MM), progressive polyradiculopathy (PP), and autonomic neuropathy (AN). Data from ACTG protocol 175 indicate that neuropathy is frequently misdiagnosed, even by experienced clinicians.3 In order to provide effective treatment, it is essential to distinguish among the various forms of neuropathy and to correctly attribute them to primary HIV infection or to other causes, such as the neurotoxic effects of antiviral agents. Although peripheral neuropathy is generally not a life-threatening disease, the debilitating pain can severely impair the quality of life of affected individuals. Of particular importance is distal sensory polyneuropathy (DSP), the most common form of peripheral neuropathy and the only one associated with the use of antiretroviral therapy. DSP affects over one third of patients with AIDS. It is rarely seen in children and is most common in the late stages of HIV disease. The clinical symptoms of DSP are numbness, burning, and tingling sensations in the feet, usually in a symmetric pattern; paresthesias or aching distally in the lower extremities; and hyperesthesia (e.g., contact sensitivity, such as with bedsheets or socks). Individuals with DSP may alter their gait in order to avoid painful pressure on their feet, which can result from even light contact. In late stages of DSP, the upper extremities may also be affected, although to a milder degree. Neurologic examination reveals depressed or absent ankle reflexes relative to the knees. While this is a …