HIV-associated peripheral neuropathy - Epidemiology, pathophysiology and treatment

Peripheral neuropathy is the most frequent neurological complication associ ated with human immunodeficiency virus type I (HIV) infection and advanced acquired immunodeficiency syndrome (AIDS). There an at least 6 patterns of HIV-associated peripheral neuropathy, although these diagnoses are often ov erlooked or misdiagnosed. Distal symmetrical polyneuropathy (DSP) is the most common form of peripher al neuropathy in HIV infection. DSP occurs mainly in patients with advanced immunosuppression and may also be secondary to the neurotoxicity of severa l antiretroviral agents. Treatment of painful DSP is primarily symptomatic, while pathogenesis-based therapies are under investigation. Reduction or d iscontinuation of neurotoxic agents should be considered if possible. Inflammatory demyelinating polyneuropathy (IDP) can present in an acute or chronic form. The acute form may occur at the time of primary HIV infection or seroconversion. Cerebrospinal fluid lymphocytic pleocytosis (10 to 50 c ells/mm(3)) is helpful in the diagnosis of HIV-associated IDP. Treatment co nsists of immunomodulatory therapy. Progressive polyradiculopathy (PP) most commonly occurs in advanced immunos uppression and usually is caused by cytomegalovirus (CMV) infection. Rapidl y progressive flaccid paraparesis, radiating pain and paresthesias, areflex ia and sphincter dysfunction are the cardinal clinical features. Rapid diag nosis and treatment with anti-CMV therapy are necessary to prevent irrevers ible neurological deficits resulting from nerve root necrosis. Mononeuropathy multiplex (MM) that occurs in early HIV infection is charact erised by self-limited sensory and motor deficits in the distribution of in dividual peripheral nerves, in advanced HIV infection, multiple nerves in t wo or more extremities or cranial nerves an affected. Treatment includes im munomodulation or anti-CMV therapy. Autonomic neuropathy may be caused by central or peripheral nervous system abnormalities. Treatment is supportive with correction of metabolic or toxi c causes. Diffuse infiltrative lymphocytosis syndrome (DILS) presents as a Sjogren's- like disorder with CD8 T cell infiltration of multiple organs. Antiretrovir al therapy and steroids may be effective treatments.