Human Immunodeficiency Virus-Neuropathy with Special Reference to Distal Sensory Polyneuropathy and Toxic Neuropathies

ABSTRACT

A variety of neurologic diseases have been associated with human immunodeficiency virus (HIV) infection either as a direct result of the virus itself (e.g.; HIV-associated dementia and HIV-related painful distal polyneuropathy) or as a result of opportunistic infections or neoplasm. HIV-related neuropathies are one of the most common neurologic complications of HIV infection. There are a variety of neuropathies in patients with HIV and can be broadly classified into (i) distal symmetric polyneuropathy (DSP); (ii) mononeuropathy multiplex; (iii) acute and chronic inflammatory demyelinating polyneuropathies; (iv) lumbosacral polyradiculopathy; (v) diffuse infiltrative lymphocytosis syndrome (DILS); (vi) autonomic neuropathy; mononeuropathies; (vii) herpes zoster radiculitis; and (viii) sensory ganglioneuritis. DSP represents the most common form of neuropathy seen in patients with HIV and affects about 30of patients and pathologic findings of DSP occurring in almost all patients with advanced immunodeficiency at autopsy. But with highly active antiretroviral treatment (HAART); the incidence of DSP appears to be decreasing compared to the pre-HAART era. But some studies show a substantial increase in the prevalence of DSP and this may be related to an increased longevity of patients and neurotoxic effects of some antiretroviral drugs. Antiretroviral toxic neuropathy (ATN) occurs with the di-deoxnucleoside group of drugs (DDI didanosine; DDC zalcitabine) and is thought to be the direct neurotoxic effect of the drugs. Clinically the two forms are indistinguishable and present in a length dependent axonal polyneuropathy. DSP and ATN cause devastating complications and related to poor treatment compliance. The objective of this review is to update the current knowledge in the two main forms of neuropathy in HIV infection and we believe that physicians practicing in the highly HIV prevalent areas (Sub-Saharan Africa and other developing countries) need to look for these complications in their HIV patients and manage them accordingly