HIV associated distal symmetric polyneuropathy (HIV-DSP)
What are the epidemiology and pathogenesis of HIV associated distal symmetric polyneuropathy?
HIV associated distal symmetric polyneuropathy (HIV-DSP) is a painful, small fiber sensory neuropathy and as such is diagnosed by skin biopsy rather than electromyography and nerve conduction studies.
It has remained remarkably common despite the introduction of ART, with prevalence >50%. HIV-DSP may be due either to side effects of ART or to direct neurotoxic effects of the virus itself.
What treatments are available for this condition?
Pain is commonly managed symptomatically with lamotrigine or topical capsaicin.
Typical medications for neuropathic pain such as amitriptyline, pregabalin, or gabapentin have shown little effect.
Halperin JJ: Lyme disease: a multisystem infection that affects the nervous system. Continuum 18(6):1338-1350, 2012.