Peripheral neuropathies in HIV infection

While the introduction of HAART [Highly active anti retoriviral therapy] hasresulted in an overall decline in the incidence and prevalence of nervous systemcomplications, peripheral neuropathy (PN) continues to be a common neurologiccomplication at every stage of HIV infection. The treating physician has to determine ifthe patient is experiencing a neuropathy due to the immune system's reaction to the virus,direct toxic effects of the virus or if the neuropathy may be attributed to the effects of theantiretroviral agents used to reduce the viral load. The spectrum of peripheral nervoussystem involvement in HIV infection includes distal symmetrical polyneuropathy (DSP),toxic neuropathy from antiretroviral drugs, diffuse infiltrative lymphocytosis syndrome(DILS), inflammatory demyelinating polyneuropathies (IDPs), multifocalmononeuropathies, and progressive polyradiculopathy. On general principles, immunemediated neuropathies tend to occur in the earlier stages of HIV infection when thepatient is relatively immunocompetent whereas neuropathies that result fromantiretroviral therapy and direct viral toxicity tend to occur later in the course of theinfection. This chapter addresses these conditions as well as the treatmentrs available forthese disorders and the neuropathic pain that often accompanies them.