Neuro

HIV Related Neuropathy

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HIV Related Neuropathy, Neuropathy in HIV, HIV Peripheral Neuropathy, HIV Associated Polyneuropathy

  • See Also
  1. Neurologic Manifestations of HIV
  2. Peripheral Neuropathy
  • Epidemiology
  1. Prevalence: 30-60% of HIV patients
  • Types
  1. Distal Sensory Polyneuropathy (most-common HIV-associated Neuropathy)
    1. Common complication at any stage of HIV Infection
    2. Risk Factors
      1. Low CD4 nadir (esp. <200 cells/uL)
      2. Antiretroviral therapy >6 months
    3. Varicella Zoster Virus (VZV) commonly involved
    4. Toxic Peripheral Neuropathy
      1. HIV Treatment with nRTI agents, especially older agents (e.g. Stavudine, Didanosine)
  2. Demyelinating Neuropathy
    1. Resembles Guillain-Barre
    2. Seen in early HIV
  3. Ascending sensorimotor Neuropathy with Incontinence or polyradiculopathy
    1. Cytomegalovirus (CMV) infection
      1. May involve the spinal cord segment
      2. May present with a painful extremity
  1. Distal lower extremity numbness, Paresthesias, or pain
  1. Decreased ankle Deep Tendon Reflexes
  2. Decreased lower extremity Sensation (esp. sharp and vibratory Sensation)
  • Differential Diagnosis
  1. See Peripheral Neuropathy
  • Management
  1. See Peripheral Neuropathy
  2. General measures
    1. Lifestyle (e.g. Exercise)
    2. Eliminate Neurotoxins (e.g. older Antiretroviral agents)
    3. Control comorbidities (e.g. Diabetes Mellitus, Alcohol Abuse)
    4. Reduce HIV Viral Load
  3. Symptomatic management
    1. Gabapentin (Neurontin)
    2. Capsaicin patches
    3. Tricyclic Antidepressants
    4. Alpha-lipoic acid
    5. Avoid Lamotrigine (low efficacy)
  • References
  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  2. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]