Annals of Tropical Medicine and Public Health
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Year : 2010  |  Volume : 3  |  Issue : 1  |  Page : 8-13

Distal symmetric polyneuropathy and toxic neuropathy in HIV patients

Department of Neurology, Faculty of Medicine, Addis Ababa University, Ethiopia

Correspondence Address:
Belachew Degefe Arasho
Department of Neurology, Faculty of Medicine, Addis Ababa University
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.76177

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Several neurological diseases have been associated with Human Immunodeficiency Virus (HIV) infection. These could either be a direct result of the virus (HIV associated dementia and HIV related painful distal polyneuropathy) or of opportunistic infections or neoplasm. HIV related neuropathy is one of the most common neurological complications of HIV infection. There are various forms of neuropathy in HIV patients which 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 30% of patients. Pathologic findings of DSP occur in almost all patients with advanced immunodeficiency at autopsy. However, with HAART, the incidence of DSP appears to be decreasing compared to the pre-HAART era. 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 anti-retroviral drugs. Anti-retroviral toxic neuropathy (ATN) occurs with the di-deoxnucleoside group of drugs (DDI, stavudine, and DDC) and is thought to be the direct neurotoxic effect of the drugs. The two forms are clinically indistinguishable and present in a length dependent axonal polyneuropathy. DSP and ATN cause devastating complications and are related to poor treatment compliance. The objective of this review is to update current knowledge in the two main forms of neuropathy in HIV infection. We believe that physicians practicing in 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.

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