eMedicine Specialties > Neurology > Neurological Infections

HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy

Author: Niranjan N Singh, MD, DNB, Fellow in Neurophysiology, Department of Neurology, St Louis University School of Medicine
Coauthor(s): Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Associate Program Director, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Contributor Information and Disclosures

Updated: Feb 23, 2007

Introduction

Background

A distal painful sensorimotor polyneuropathy is the most common type of HIV-1 associated peripheral neuropathy. It usually develops during late HIV infection.

Pathophysiology

More than one pathophysiologic mechanism likely exists:

  • HIV may act directly by infecting dorsal root ganglion neurons.
  • These neurons may also be injured by locally infiltrating activated macrophages that secrete neurotoxic cytokines or other metabolites.
  • Several studies from the HAART era show a lack of association between distal painful sensorimotor polyneuropathy and the degree of immunosuppression, including low CD4 counts and high HIV viral load.
  • Distal epidermal denervation has shown to be associated with distal painful sensorimotor polyneuropathy.
  • Other factors may be involved, including nutritional and vitamin deficiencies.
  • Since the advent of highly active antiretroviral therapy (HAART) (eg, didanosine, stavudine, zalcitabine, rarely lamivudine), antiretroviral toxic neuropathy (ATN), which occurs in up to 60% of patients and likely results from mitochondrial dysfunction, has been recognized.

Frequency

United States

Distal painful sensorimotor polyneuropathy is clinically apparent in 10-30% of patients with AIDS. Subclinical forms occur in many more patients who are HIV positive. It is found at autopsy in almost 100% of patients with AIDS. The prevalence of distal painful sensorimotor polyneuropathy continues to rise because of increased life expectancy in the HAART era.

Sex

Distal painful sensorimotor polyneuropathy is more prevalent in males than in females.

Age

Distal painful sensorimotor polyneuropathy is more common in persons older than 50 years. It rarely occurs in children.

Clinical

History

  • Painful feet (including soles) that are sensitive to light touch
  • Distal numbness
  • Distal weakness in the more advanced stage
  • Autonomic symptoms referable to urogenital and intestinal function
  • Rare in otherwise healthy seropositive patients
  • Can be asymptomatic

Physical

  • Panmodal distal sensory loss
  • Mild distal weakness
  • Hyporeflexia or areflexia
  • Symmetric presentation
  • Autonomic signs (often can be elicited by careful evaluation)

More on HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy

Overview: HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy
Differential Diagnoses & Workup: HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy
Treatment & Medication: HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy
Follow-up: HIV-1 Associated Distal Painful Sensorimotor Polyneuropathy
References
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References

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  2. Cornblath DR, Hoke A. Recent advances in HIV neuropathy. Curr Opin Neurol. 2006;5:446-50. [Medline].

  3. Estanislao L, Carter K, McArthur J, et al. A randomized controlled trial of 5% lidocaine gel for HIV-associated distal symmetric polyneuropathy. J Acquir Immune Defic Syndr. Dec 15 2004;37(5):1584-6. [Medline].

  4. Ferrari S, Vento S, Monaco S, et al. Human immunodeficiency virus-associated peripheral neuropathies. Mayo Clin Proc. Feb 2006;81(2):213-9. [Medline].

  5. Freeman R, Roberts MS, Friedman LS, Broadbridge C. Autonomic function and human immunodeficiency virus infection. Neurology. Apr 1990;40(4):575-80. [Medline].

  6. Gendelman HE, Lipton SA, Epstein L. The Neurology of AIDS. New York: Chapman & Hall;1998.

  7. Hart AM, Wilson AD, Montovani C, et al. Acetyl-l-carnitine: a pathogenesis based treatment for HIV-associated antiretroviral toxic neuropathy. AIDS. Jul 23 2004;18(11):1549-60. [Medline].

  8. Kieburtz K, Simpson D, Yiannoutsos C, et al. A randomized trial of amitriptyline and mexiletine for painful neuropathy in HIV infection. AIDS Clinical Trial Group 242 Protocol Team. Neurology. Dec 1998;51(6):1682-8. [Medline].

  9. Luciano CA, Pardo CA, McArthur JC. Recent developments in the HIV neuropathies. Curr Opin Neurol. Jun 2003;16(3):403-9. [Medline].

  10. Maschke M, Kastrup O, Esser S, et al. Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry. Sep 2000;69(3):376-80. [Medline].

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  13. Schifitto G, McDermott MP, McArthur JC, et al. Incidence of and risk factors for HIV-associated distal sensory polyneuropathy. Neurology. Jun 25 2002;58(12):1764-8. [Medline].

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  16. Watters MR, Poff PW, Shiramizu BT, et al. Symptomatic distal sensory polyneuropathy in HIV after age 50. Neurology. Apr 27 2004;62(8):1378-83. [Medline].

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Further Reading

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Keywords

acquired immunodeficiency syndrome, AIDS, HIV-1 associated peripheral neuropathy, HIV infection, neurotoxic drugs, vitamin deficiencies, nutritional deficiencies, drug toxicity, didanosine, stavudine, zalcitabine, lamivudine

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Contributor Information and Disclosures

Author

Niranjan N Singh, MD, DNB, Fellow in Neurophysiology, Department of Neurology, St Louis University School of Medicine
Niranjan N Singh, MD, DNB is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Coauthor(s)

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Associate Program Director, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Medical Editor

William J Nowack, MD, Associate Professor, Department of Neurology, Epilepsy Center, University of Kansas Medical Center
William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Electroencephalographic Association, American Medical Informatics Association, and Biomedical Engineering Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Glenn Lopate, MD, Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Chief of Neurology, St Louis ConnectCare, Consulting Staff, Barnes Jewish Hospital
Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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