Abstract
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.
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Kara Stavros declares that she has no conflict of interest.
David M. Simpson reports personal fees from Astellas, Acorda, Pfizer, Depomed, grants from Astellas, Pfizer, and outside the submitted work.
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Stavros, K., Simpson, D.M. Understanding the Etiology and Management of HIV-Associated Peripheral Neuropathy. Curr HIV/AIDS Rep 11, 195–201 (2014). https://doi.org/10.1007/s11904-014-0211-2
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DOI: https://doi.org/10.1007/s11904-014-0211-2