Neuropathic Pain in HIV Disease

David M. Simpson, MD

Professor of Neurology
Mount Sinai School of Medicine
New York, NY

Peripheral neuropathy is one of the most common neurologic complications of HIV. In fact, nearly 50% of HIV patients are thought have signs of neuropathy, with increased risk in those with advanced disease. Assessment and treatment of these patients can be complicated by antiretroviral agents, which themselves are often neurotoxic. Neurologic effects may be cognitive, such as impaired memory or vision, and/or sensatory, including numbness, tingling, and pain. Electromyography and skin biopsy may assist in a diagnosis. Attempts at regenerative therapy have not yet proved effective, and treatment of HIV-associated peripheral neuropathy is primarily symptomatic. Of note, placebo-controlled clinical trials of some analgesic agents that are traditionally used to treat neuropathic pain have failed to show significant benefit. Some clinical success, however, has been demonstrated with lamotrigine, gabapentin, and a new high-concentration capsaisin patch. Here, Dr. Simpson discusses current barriers to treatment and available therapeutic options in this challenging disease.

References

Simpson DM, Kitch D, Evans SR, et al. HIV neuropathy natural history cohort study. Neurology. 2006;66:1679-1687.
Simpson DM, Haidich AB, Schifitto G, et al. Severity of HIV-associated neuropathy is associated with plasma HIV-1 RNA levels. AIDS. 2002;16:407-412.
Sacktor N. The epidemiology of human immunodeficiency virus-associated neurological disease in the era of highly active antiretroviral therapy. J Neurovirol. 2002;8(suppl 2):115-121.
Childs EA, Lyles RH, Selnes OA, et al. Plasma viral load and CD4 lymphocytes predict HIV-associated dementia and sensory neuropathy. Neurology. 1999;52:607-13.

Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.

Buckley DI, Calvert JF, Lapidus JA, et al.
Ann Fam Med. 2010;8(3):237-44.
PURPOSE:...

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Beck JG, Clapp JD.
Psychol Trauma. 2011 Jun;3(2):101-108.
Many traumatic events leave...

The impact of enrollment in a specialized interdisciplinary neuropathic pain clinic

Garven A, Brady S, Wood S, Hatfield M, Bestard J, Korngut L, Toth C.
Pain Res Manag. 2011...

Association between urine drug test results and treatment outcome in high-risk chronic pain patients on opioids

Barth KS, Becker WC, Wiedemer NL, Mavandadi S, Oslin DW, Meghani SH, Gallagher RM.
J Addict...

The role of core strengthening for chronic low back pain.

Akuthota V, Standaert CJ, Chimes GP.
PM R. 2011 Jul;3(7):664-70.