Complications of Antiretroviral Therapy (JM Kilby, Section Editor)

Current HIV/AIDS Reports

, Volume 11, Issue 3, pp 195-201

First online:

Understanding the Etiology and Management of HIV-Associated Peripheral Neuropathy

  • Kara StavrosAffiliated withDepartment of Neurology, Icahn School of Medicine at Mount Sinai
  • , David M. SimpsonAffiliated withDepartment of Neurology, Icahn School of Medicine at Mount Sinai Email author 

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HIV may cause several forms of peripheral neuropathy, the most common of which is distal symmetric polyneuropathy (DSP) characterized by pain and sensory deficits in a stocking-glove distribution. The pathophysiology of DSP remains largely unknown but is thought to be related both to the neurotoxicity of HIV—through indirect immunomodulatory mechanisms—and to the neurotoxic effects of anti-retroviral therapies, most notably the dideoxynucleoside reverse transcription inhibitors or so-called d-drugs. Determining whether symptoms arise from the virus or the treatment poses a challenge to the clinician who must decide if a patient’s HAART regimen should be altered. Treatment of symptoms related to HIV-DSP is a difficult task and there is no evidence that the traditional agents used in chronic neuropathic pain are efficacious in the HIV-DSP population. Indeed few pharmacologic agents have proven efficacy in HIV-DSP – these include cannabis and the capsaicin 8 % dermal patch. As such, alternative, non-pharmacologic therapies are being investigated. More research is needed to further elucidate the complex pathophysiology of HIV-DSP which may yield additional therapies for these patients.


HIV Peripheral neuropathy Distal symmetric polyneuropathy, DSP Anti-retroviral Pain