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Peripheral neuropathies associated with HIV infection
Which kinds of peripheral neuropathies are associated with HIV infection?
Up to 50% of patients with HIV infection develop a peripheral neuropathy, which may take one or a combination of the following forms:
1. Distal symmetric neuropathy (30% to 60%)—Patients normally present with a stocking-glove pattern of numbness and paresthesias, hyporeflexia, and pain/temperature/vibratory loss with minimal motor weakness. Autonomic symptoms are often seen. Severity has not been correlated with low CD4 count or high viral load, but is associated with older age, height, statin use, substance abuse, diabetes, and triglyceridemia.
2. Acute inflammatory demyelinating polyneuropathy (AIDP) is associated with acute seroconversion and CIDP is more common in patients with HIV.
3. Mononeuropathy multiplex—early and mild in HIV infection or more severe associated with CMV, varicella, and hepatitis C infections
4. Polyradiculopathy—usually late (associated with CMV, herpes zoster, syphilis, lymphomatous)
5. Cranial and compressive neuropathies similar to the general population
6. Nutritional or vitamin deficiency neuropathy
7. Drug-induced neuropathy (associated with both nucleoside reverse transcription inhibitors and protease inhibitors)
Sources
Kumar N, Gross JB, Ahiskig JE: Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology 63:33-39, 2004. Goodman BP, Bosch EP, Ross MA, et al: Clinical and electrodiagnostic findings in copper deficiency myeloneuropathy. J Neurol Neurosurg Psychiatry 80:524-527, 2009. Mygland A, Skarpass T, Ljøstad U: Chronic polyneuropathy and Lyme disease. Eur J Neurol 13:1213-1215, 2006. Said G: Infectious neuropathies. Neurol Clin 25:115-137, 2007. Halperin JJ: Nervous system Lyme disease. Infect Dis Clin North Am 29(2):241-253, 2015.
