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Disorders of peripheral nerves are among the most frequent neurological complications of HIV infection. With increasing survival of patients with HIV, the number of patients who have HIV neuropathy is increasing worldwide. HIV can affect peripheral sensory and motor nerves, thoracic nerves, cranial nerves or autonomic nerves. HIV neuropathy can manifest itself in multiple ways. It can affect multiple sensory and motor nerves in distal parts of the limbs and cause HIV polyneuropathy. Sometimes this type of neuropathy is due to a group of anti-HIV medications and is called antiretroviral toxic neuropathy. HIV can also affect one nerve at a time (HIV mononeuropathy) or cause an inflammatory neuropathy similar to Guillain-Barre syndrome (GBS).
The symptoms of HIV neuropathy depend on the type of neuropathy. In HIV polyneuropathy, the patient may experience unusual sensations (paresthesias), numbness and pain in their hands and feet. Often non-painful stimuli, such as touching, can elicit pain sensation. In addition, at later stages of the illness, there may be weakness of the muscles in the feet and hands. In HIV mononeuropathy, the symptoms depend on which nerve is affected. For example, it can affect thoracic nerves and cause numbness and pain in the chest wall or it can affect cranial nerves and cause sensory or motor deficits in the face. In rare cases where HIV causes a GBS-like illness, the symptoms will be very similar to typical GBS.
Diagnosis of HIV neuropathies is based on history, clinical examination and supporting laboratory investigations. These include electromyography with nerve conduction studies, skin biopsies to evaluate cutaneous nerve innervation, and nerve and muscle biopsies for histopathological evaluation.
Treatment of HIV neuropathies depends on the type. Typical HIV polyneuropathy requires good control of HIV infection. Antiretroviral toxic neuropathy may require the cessation of the offending drug. Neuropathic pain due to HIV polyneuropathy can be treated with anti-seizure medications, antidepressants, or analgesics including opiate drugs. In severe painful conditions, patients may be referred to the Blaustein Chronic Pain Clinic for a multidisciplinary approach to pain management. Patients with GBS due to HIV are treated in a similar manner to other GBS patients.
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