HIV-Related Neuropathy

Catherine L. Cherry, MBBS, PhD

Infectious Diseases Unit
The Alfred Hospital
Burnet Institute
Department of Medicine
Monash University
Melbourne, Australia

HIV patients are at increased risk for a range of nervous system pathologies, and in particular peripheral sensory neuropathies. HIV is associated with a typical small-fiber neuropathy, characterized predominantly by sensory loss and/or neuropathic pain in the lower limbs. Clinically, patients present with reduced sensation and diminished ankle-jerk reflexes, but without associated muscle wasting or weakness. HIV does not appear to infect neurons, but HIV-produced proteins, such as Gp-120, are clearly neurotoxic. Moreover, several antiretroviral drugs have been identified as independent risk factors for neuropathy. HIV-induced and treatment-induced neuropathies are difficult to distinguish aside from the temporal onset of the latter relative to the initiation of pharmacotherapy, and it is possible that the two may, in fact, both contribute to the disease. Recent research has indicated that increased height and age are almost universally associated with greater risk of neuropathy in HIV. Here, Dr. Cherry give an overview of HIV-associated neuropathies discusses her research into neuropathy risk factors, such as age and height, as markers to prescreen HIV patients and help shape therapy.

References

Cherry CL, Affandi JS, Imran D, et al. Age and height predict neuropathy risk in patients with HIV prescribed stavudine. Neurology. 2009;73:315-320.
Pettersen J, Jones G, Worthington C, et al. Sensory neuropathy in human immunodeficiency virus/acquired immunodeficiency syndrome patients: protease inhibitor mediated neurotoxicity. Ann Neurol. 2006;59:816-824.
Cheng YJ, Gregg EW, Kahn HS, et al. Peripheral insensate neuropathy: a tall problem for US adults? Am J Epidemiol. 2006;164:873-880.
Morgello S, Estanislao L, Simpson D, et al. HIV associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy: The Manhattan HIV Brain Bank. Arch Neurol. 2004;61:546-551.

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